Generic Interface System

Generic Interface System (GIS) Version 3.01 Based on HL7 Standard Version 2.4 Mapping Document HL7 Segments to IHS Files July 2001

TABLE OF CONTENTS Cross Reference: HL7 Segments to IHS Files Contents 1.0 DG1 DIAGNOSIS (2.4)... 1 2.0 ERR ERROR (2.4)... 3 3.0 EVN - EVENT TYPE (2.4)... 4 4.0 GT1 GUARANTOR INFORMATION (2.4)... 5 5.0 IN1 INSURANCE (2.4)... 8 6.0 IN2 - INSURANCE ADDITIONAL INFORMATION (2.4)... 12 7.0 MFA - MASTER FILE ACKNOWLEDGMENT (2.4)... 15 8.0 MFE - MASTER FILE ENTRY (2.4)... 16 9.0 MFI - MASTER FILE IDENTIFICATION (2.4)... 17 10.0 MSA - MESSAGE ACKNOWLEDGMENT (2.4)... 18 11.0 MSH - MESSAGE HEADER (2.4)... 19 12.0 NK1 - NEXT OF KIN / ASSOCIATED PARTIES (2.4)... 20 13.0 NTE - NOTES AND COMMENTS (2.4)... 24 14.0 OBR - OBSERVATION REQUEST (2.4) V MEASUREMENT (9000010.01)... 25 15.0 OBR - OBSERVATION REQUEST (2.4) V EYE GLASS (9000010.04)... 28 16.0 OBR - OBSERVATION REQUEST (2.4) V LAB (9000010.09)... 31 17.0 OBR - OBSERVATION REQUEST (2.4) V SKIN TEST (9000010.12)... 34 18.0 OBR - OBSERVATION REQUEST (2.4) V EXAM FILE (9000010.13)... 37 19.0 OBR - OBSERVATION REQUEST (2.4) V TREATMENT (9000010.15)... 40 20.0 OBR - OBSERVATION REQUEST (2.4) V PATIENT ED (9000010.16)... 43 21.0 OBR - OBSERVATION REQUEST (2.4) V PHYSICAL THERAPY (9000010.17)... 46 22.0 OBR - OBSERVATION REQUEST (2.4) V CPT (9000010.18)... 49 23.0 OBR - OBSERVATION REQUEST (2.4) V DIAGNOSTIC PROCEDURE (9000010.21)... 52 IHS Generic HL7 Message Generator/Filer V 2.0 i July 2001

24.0 OBR - OBSERVATION REQUEST (2.4) V RADIOLOGY (9000010.22)... 55 25.0 OBR - OBSERVATION REQUEST (2.4) V HEALTH FACTORS (9000010.23)... ERROR! BOOKMARK NOT DEFINED. 26.0 OBX - OBSERVATION / RESULT (2.4) V MEASUREMENT (9000010.01)... 61 27.0 OBX - OBSERVATION / RESULT (2.4) V EYE GLASS (9000010.04)... 63 28.0 OBX - OBSERVATION / RESULT (2.4) V LAB (9000010.09)... 67 29.0 OBX - OBSERVATION / RESULT (2.4) V SKIN TEST (9000010.12)... 69 30.0 OBX - OBSERVATION / RESULT (2.4) V EXAM (9000010.13)... 71 31.0 OBX - OBSERVATION / RESULT (2.4) V TREATMENT (9000010.15)... 73 32.0 OBX - OBSERVATION / RESULT (2.4) V PATIENT ED (9000010.16)... 75 33.0 OBX - OBSERVATION / RESULT (2.4) V PHYSICAL THERAPY (9000010.17)... 77 34.0 OBX - OBSERVATION / RESULT (2.4) V CPT (9000010.18)... 79 35.0 OBX - OBSERVATION / RESULT (2.4) V DIAGNOSTIC PROCEDURE (9000010.21)... 81 36.0 OBX - OBSERVATION / RESULT (2.4) V RADIOLOGY (9000010.22)... 83 37.0 OBX - OBSERVATION / RESULT (2.4) V HEALTH FACTORS (9000010.23)... 85 38.0 ORC - COMMON ORDER (2.4)... 87 39.0 PD1 - PATIENT DEMOGRAPHIC (2.4)... 89 40.0 PID - PATIENT IDENTIFICATION (2.4)... 90 41.0 PR1 PROCEDURES (2.4)... 92 42.0 PV1 - PATIENT VISIT (2.4)... 94 43.0 QAK QUERY ACKNOWLEDGEMENT (QAK) (2.4)... 98 44.0 QRD QUERY DEFINITION (2.4)... 99 45.0 QRF QUERY FILTER (2.4)... 100 46.0 RXA - PHARMACY / TREATMENT ADMINISTRATION (2.4)... 101 47.0 RXD - PHARMACY / TREATMENT DISPENSE (2.4)... 103 48.0 RXR PHARMACY/TREATMENT ROUTE (2.4)... 105 49.0 ZDX - IHS DIAGNOSIS EXTENSION (2.4)... 106 IHS Generic HL7 Message Generator/Filer V 2.0 ii July 2001

50.0 ZFD IHS DRUG FILE UPDATE (2.4)... 107 51.0 ZP1 - IHS PATIENT INFORMATION: HEALTH RECORD IDENTIFIERS (2.4) (OBSOLETE, NOW IN PID-3)... 108 52.0 ZP2 - IHS PATIENT INFORMATION (2.4)... 109 53.0 ZP3 - IHS PATIENT INFORMATION: OTHER TRIBES (2.4)...111 54.0 ZP4 - IHS PATIENT INFORMATION: PREVIOUS COMMUNITY (2.4)... 112 55.0 ZPR - IHS PROCEDURE EXTENSION (2.4)... 113 56.0 ZRA - IHS PHARMACY / TREATMENT ADMINISTRATION EXTENSION (2.4)... 114 57.0 ZV1 - IHS PATIENT VISIT (2.4)... 115 IHS Generic HL7 Message Generator/Filer V 2.0 iii July 2001

1.0 0B0BDG1 Diagnosis (2.4) The DG1 segment contains patient diagnosis information of various types, for example, admitting, primary, etc. The DG1 segment is used to send multiple diagnoses (for example, for medical records encoding). In the IHS implementation, each DG1 is followed by one ZDX. DG1 attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 1 4 SI R 00375 Set ID - Diagnosis sequential in each message from 1 to n 2 2 ID R 0053 00376 Diagnosis Coding Method 3 250 CE O 0051 00377 Diagnosis Code Patient: 9000001, 1114 [underlying cause of death] V Hosp.: 9000010.02,.12 [admitting dx] V CHS: 9000010.03,.09 [newborn dx] V POV: 9000010.07,.01 [pov] ptr to ICD Diagnosis: 80,.01 [code number] and 3 [diagnosis] ptr to ICD Diagnosis: 80,.01 [code number] and 3 [diagnosis] ptr to ICD Diagnosis: 80,.01 [code number] and 3 [diagnosis] ptr to ICD Diagnosis: 80,.01 [code number] and 3 [diagnosis] (this field works with diagnosis type field below, DG1:6) 4 40 ST B 00378 Diagnosis Description 5 26 TS O 00379 Diagnosis Date/Time 6 2 IS R 0052 00380 Diagnosis Type site-defined table... see notes in next column. (Table 0052 - user defined) 7 250 CE B 0118 00381 Major Diagnostic Category for patient, 9000001, 1114 (Underlying cause of death) use with a type code DH. for admitting, use with type code AD for newborn, use with type code NB (also, PV1:36, Newborn Baby Indicator must be Y ) for Purpose of Visit, use with code PV for other dx types, use appropriate dx type (to be specified in sitedefined table associated with this field) IHS Generic HL7 Message Generator/Filer V 2.0 1 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 8 250 CE B 0055 00382 Diagnostic Related Group 9 1 ID B 0136 00383 DRG Approval Indicator 10 2 IS B 0056 00384 DRG Grouper Review Code 11 250 CE B 0083 00385 Outlier Type 12 3 NM B 00386 Outlier Days 13 12 CP B 00387 Outlier Cost 14 4 ST B 00388 Grouper Version And Type 15 2 ID O 0359 00389 Diagnosis Priority V POV: 9000010.07,.12 Use IHS set (code only P or S) [primary/secondary] 16 250 XCN O Y 00390 Diagnosing Clinician 17 3 IS O 0228 00766 Diagnosis Classification 18 1 ID O 0136 00767 Confidential Indicator 19 26 TS O 00768 Attestation Date/Time IHS Generic HL7 Message Generator/Filer V 2.0 2 July 2001

2.0 1B1BERR Error (2.4) The ERR segment is used to add error comments to acknowledgment messages. ERR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File IHS Notes Reference 1 80 CM R Y 00024 Error Code and Location may be used for additional information: site-defined IHS Generic HL7 Message Generator/Filer V 2.0 3 July 2001

3.0 2B2BEVN - Event Type (2.4) The EVN segment is used to communicate necessary trigger event information to receiving applications. Valid event types for all messages are contained in HL7 Table 0003 - Event Type Code. EVN attributes LEN DT R/O RP/# TBL ITEM# ELEMENT NAME IHS File IHS Notes SEQ # Reference 1 3 ID B 0003 00099 Event Type Code HL7 Event Type Code: 779.001,.01 [code] - See Note 2. IHS-supported events listed elsewhere 2 26 TS R 00100 Date/Time of Event See Notes 3 & 4, below 3 26 TS O 00101 Date/Time Planned Event 4 3 IS O 0062 00102 Event Reason Code 5 250 XCN O Y 0188 00103 Operator ID 6 26 TS O 01278 Event Occurred 7 180 HD O 01534 Event Facility Notes: 1. EVN segment is somewhat redundant, but it is required for ADT events (except for the response to the A19 - ADT record-oriented query). 2. EVN:1, event type code is a duplicate of MSH:9,2, trigger event... but use since this a required field. 3. EVN:2, event date/time is a duplicate of the transaction date (MSH:7) -- but since this is a required field, use the transaction date on update, A08, & merge events, (not needed for query return, A19, since this segment is optional for that event ) 4. EVN:2: Visit start date (aka visit admit date/time, PV1:44), visit end date (aka visit discharge/checkout date/time, PV1:45), date/time of last update for patient file (ZP1:8), and date/time of last reg update for patient file (ZP1:2) would not be used for this field since we re not using admit (A01), or discharge (A03) events, and the HL7 update event (A08) doesn t distinguish between a patient demographic or a patient reg update. IHS Generic HL7 Message Generator/Filer V 2.0 4 July 2001

4.0 3B3BGT1 Guarantor Information (2.4) The GT1 segment contains guarantor (e.g., the person or the organization with financial responsibility for payment of a patient account) data for patient and insurance billing applications. It contains the Policy holder information from RPMS. GT1 attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File IHS Notes Reference 1 4 SI R 00405 Set ID GT1 2 250 CX O Y 00406 Guarantor Number 9000003.1,.04 [Policy Number] 3 250 XPN R Y 00407 Guarantor Name 9000003.1,.01 [Name of Insured] 4 250 XPN O Y 00408 Guarantor Spouse Name 5 250 XAD O Y 00409 Guarantor Address 9000003.1,.11,.12,.13, [Address] 6 250 XTN O Y 00410 Guarantor Ph Num 9000003.1,14 [Phone Number] Home 7 250 XTN O Y 00411 Guarantor Ph Num Business 8 26 TS O 00412 Guarantor Date/Time of 9000003.1,.19 [Date of Birth] Birth 9 1 IS O 0001 00413 Guarantor Sex 9000003.1,.08 [Sex] 10 2 IS O 0068 00414 Guarantor Type 11 250 CE O 0063 00415 Guarantor Relationship 12 11 ST O 00416 Guarantor SSN 13 8 DT O 00417 Guarantor Date Begin 9000003.1,.17 [Effective Date] 14 8 DT O 00418 Guarantor Date End 9000003.1,.18 [Expiration Date] 15 2 NM O 00419 Guarantor Priority 16 250 XPN O Y 00420 Guarantor Employer 9999999.75,.01 [Employer] Name 17 250 XAD O Y 00421 Guarantor Employer Address 9999999.75,.02,.03,.04,.05 [Street Address, City, State, Zip] 18 250 XTN O Y 00422 Guarantor Employee 9999999.75,.06 [Phone Number] Phone Number 19 20 CX O Y 00423 Guarantor Employee ID Number 20 2 IS O 0066 00424 Guarantor Employment Status 9000003.1,.15 [Holders Employment Status] 21 250 XON O Y 00425 Guarantor Organization Name 22 1 ID O 0136 00773 Guarantor Billing Hold Flag IHS Generic HL7 Message Generator/Filer V 2.0 5 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File IHS Notes Reference 23 250 CE O 00774 Guarantor Credit Rating Code 24 26 TS O 00775 Guarantor Death Date and Time 25 1 ID O 0136 00776 Guarantor Death Flag 26 250 CE O 0218 00777 Guarnator Charge Adjustment Code 27 10 CP O 00778 Guarantor Household Income 28 3 NM O 00779 Guarator Household Size 29 250 CX O Y 00780 Guarantor Employer ID Number 30 250 CE O 0002 00781 Guarantor Marital Status Code 31 8 DT O 00782 Guarantor Hire Effective Date 32 8 DT O 00783 Employment Stop Date 33 2 IS O 0223 00755 Living Dependency 34 2 IS O 0009 00145 Ambulatory Status 35 250 CE O 0171 00129 Citizenship 36 250 CE O 0296 00118 Primary Language 37 2 IS O 0220 00742 Living Arrangement 38 250 CE O 0215 00743 Publicity Indicator 39 1 ID O 0136 00744 Protection Indicator 40 2 IS O 0231 00745 Student Indicator 41 250 IS O 0006 00120 Religion 42 250 XPN O 00746 Mother s Maiden Name 43 250 CE O 0212 00739 Nationality 44 250 CE O 0189 00125 Ethnic Group 45 250 XPN O Y 00748 Contact Person Name 46 250 XTN O Y 00749 Contact Person s Telephone Number 47 250 CE O 0222 00747 Contact Reason 48 2 IS O 0063 00784 Contact Relationship 49 20 ST O 00785 Job Title 50 20 JCC O 00786 Job Code/Class 51 250 XON O Y 01232 Guarantor Employer s Organization Name 52 2 IS O 0310 00753 Handicap 53 2 IS O 0311 00752 Job Status Cross Reference: HL7 Segments to IHS Files IHS Generic HL7 Message Generator/Filer V 2.0 6 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File IHS Notes Reference 54 50 FC O 0064 01231 Guarantor Financial Class 55 250 CE O Y 0005 01292 Guarantor Race IHS Generic HL7 Message Generator/Filer V 2.0 7 July 2001

5.0 4B4BIN1 Insurance (2.4) The IN1 segment contains insurance policy coverage information necessary to produce properly pro-rated and patient and insurance bills. For IHS purposes, there are three types of insurance: Medicare, Medicaid, and private-party. The IHS File References and IHS Notes columns will reflect this by the use of MCR, MCD, and PVT, respectively. IN1 attributes SEQ LEN DT R/O RP/# TBL ITEM # ELEMENT NAME IHS File Reference IHS Notes # 1 4 SI R 00426 Set ID - IN1 numeric index; 1 to n 2 250 CE R 0072 00368 Insurance Plan Id 3 250 CX R Y 00428 Insurance Company ID 4 250 XON O Y 00429 Insurance Company Name PVT: Policy Holder: 9000003.1,.03 [insurance company] 5 250 XAD O Y 00430 Insurance Company Address 6 250 XPN O Y 00431 Insurance Co. Contact Person 7 250 XTN O Y 00432 Insurance Co. Phone Number 8 12 ST O 00433 Group Number MCR: Medicare Eligible: 9000003,.04 [suffix] MCD: Medicaid Eligible: 9000004.11,.04 [state] PVT: Policy Holder: 9000003.1,.06 [group name] MCR: MEDICARE MCD: MEDICAID PVT: ptr to Insurer: 9999999.18,.01 [name] 9 250 XON O Y 00434 Group Name 10 250 CX O Y 00435 Insured s Group Emp. ID 11 250 XON O Y 00436 Insured s Group Emp Name MCR: ptr to Medicare Suffix: 9999999.32,.01 [code] PVT: ptr to Employer Group Insurance: 9999999.77,.02 [group number] IHS Generic HL7 Message Generator/Filer V 2.0 8 July 2001

SEQ LEN DT R/O RP/# TBL ITEM # ELEMENT NAME IHS File Reference IHS Notes # 12 8 DT O 00437 Plan Effective Date MCR: Medicare Eligible: 9000003.11,.01 [elig.date] MCD: Medicaid Eligible: 9000004.11,.01 [elig. date] PVT: Policy Holder: 9000003.1,.17 [effective date] 13 8 DT O 00438 Plan Expiration Date MCR: Medicare Eligible: 9000003.11,.02 [elig. end date] MCD: Medicaid Eligible: 9000004.11,.02 [elig. end date] PVT: Policy Holder: 9000003.1,.18 [expiration date] 14 250 CM O 00439 Authorization Information 15 3 IS O 0086 00440 Plan Type 16 250 XPN O Y 00441 Name Of Insured MCR: Medicare Eligible: 9000003,.05 [name of insured] MCD: Medicaid Eligible: 9000004, 2101 [medicaid name] PVT: Policy Holder: 9000003.1,.01 [name of policy holder] 17 250 CE O 0063 00442 Insured s Relationship to Patient MCR: SF MCD: SF PVT: Need to identify relationship of patient to insured, then take inverse of 18 26 TS O 00443 Insured s Date of Birth PVT: Policy Holder: 9000003.1,.19 [date of birth] that. MCR: MCD: IHS Generic HL7 Message Generator/Filer V 2.0 9 July 2001

SEQ LEN DT R/O RP/# TBL ITEM # ELEMENT NAME IHS File Reference IHS Notes # 19 250 XAD O Y 00444 Insured s Address PVT: Policy Holder: 9000003.1 MCR: MCD:.09 [holder s address - street].11 [holder s address - city].12 [holder s address - state].13 [holder s address - zip] 20 2 IS O 0135 00445 Assignment Of Benefits 21 2 IS O Y 0173 00446 Coordination Of Benefits 22 2 ST O 00447 Coord Of Ben. Priority 23 2 ID O 0136 00448 Notice Of Admission Flag 24 8 DT O 00449 Notice Of Admission Date 25 1 ID O 0136 00450 Report Of Eligibility Flag 26 8 DT O 00451 Report Of Eligibility Date 27 2 IS O 0093 00452 Release Information Code 28 15 ST O 00453 Pre-Admit Cert (PAC) 29 26 TS O 00454 Verification Date/Time 30 250 XCN O Y 00455 Verification By 31 2 IS O 0098 00456 Type Of Agreement Code 32 2 IS O 0022 00457 Billing Status 33 4 NM O 00458 Lifetime Reserve Days 34 4 NM O 00459 Delay Before L.R. Day 35 8 IS O 0042 00460 Company Plan Code 36 15 ST O 00461 Policy Number 37 12 CP O 00462 Policy Deductible 38 12 CP O 00463 Policy Limit - Amount 39 4 NM O 00464 Policy Limit - Days 40 12 CP B 00465 Room Rate - Semi- Private 41 12 CP B 00466 Room Rate - Private IHS Generic HL7 Message Generator/Filer V 2.0 10 July 2001

SEQ LEN DT R/O RP/# TBL ITEM # ELEMENT NAME IHS File Reference IHS Notes # 42 250 CE O 0066 00467 Insured s Employment Status 43 1 IS O 0001 00468 Insured s Sex MCD: Medicaid Eligible: MCR: 9000004,.07 [sex of insured] PVT: Policy Holder: 9000003.1,.08 [policy holder s sex] 44 250 XAD O Y 00469 Insured s Employer Address 45 2 ST O 0076 00470 Verification Status 46 8 IS O 0072 00471 Prior Insurance Plan ID 47 3 IS O 0309 01227 Coverage Type MCR: Medicare Eligible: 9000003.11,.03 [coverage type] MCD: Medicaid Eligible: 9000004.11,.03 [coverage type] PVT: Policy Holder: 9000003.1,.05 [coverage type] 48 2 IS O 0310 00753 Handicap 49 250 CX O Y 01230 Insured s ID Number MCR: Medicare Eligible: 9000003,.03 [medicare number] MCD: Medicaid Eligible: 9000004,.03 [medicaid number] PVT: Policy Holder: 9000003.1,.04 [policy number] PVT: ptr to Coverage Type: 9999999.65,.01 [name] (See IHS TABLE INSURANCE COVERAGE TYPE) IHS Generic HL7 Message Generator/Filer V 2.0 11 July 2001

6.0 5B5BIN2 - Insurance Additional Information (2.4) The IN2 segment contains additional insurance policy coverage and benefit information necessary for proper billing and reimbursement. Fields used by this segment are defined by HCFA or other regulatory agencies. IN2 attributes SEQ LEN DT R/O RP/# TBL# ITEM ELEMENT NAME IHS File Reference IHS Notes # 1 250 CX O Y 00472 Insured s Employee ID 2 11 ST O 00473 Insured s Social Security Number 3 250 XCN O Y 00474 Insured s Employer Name Policy Holder: 9000003.1,.16 [employer] -> Employer: 9999999.18,.01 [name] 4 1 IS O 0139 00475 Employer Information Data 5 1 IS O Y 0137 00476 Mail Claim Party 6 15 ST O 00477 Medicare Health Ins Card Number Medicare Eligible: 9000003,.03 [medicare number] 7 250 XPN O Y 00478 Medicaid Case Name 8 15 ST O 00479 Medicaid Case Number Medicaid Eligible: 9000004,.13 [case number] 9 250 XPN O Y 00480 Champus Sponsor Name 10 20 ST O 00481 Champus ID Number 11 250 CE O 0342 00482 Dependent of Champus Recipient 12 25 ST O 00483 Champus Organization 13 25 ST O 00484 Champus Station 14 14 IS O 0140 00485 Champus Service 15 2 IS O 0141 00486 Champus Rank/Grade 16 3 IS O 0142 00487 Champus Status 17 8 DT O 00488 Champus Retire Date 18 1 ID O 0136 00489 Champus Non-Avail Cert On File 19 1 ID O 0136 00490 Baby Coverage 20 1 ID O 0136 00491 Combine Baby Bill 21 1 ST O 00492 Blood Deductible 22 250 XPN O Y 00493 Special Coverage Approval Name 23 30 ST O 00494 Special Coverage Approval Title IHS Generic HL7 Message Generator/Filer V 2.0 12 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM ELEMENT NAME IHS File Reference IHS Notes # 24 8 IS O Y 0143 00495 Non-Covered Insurance Code 25 250 CX O Y 00496 Payor ID 26 250 CX O Y 00497 Payor Subscriber ID 27 1 IS O 0144 00498 Eligibility Source 28 250 CM O Y 0145/0146 00499 Room Coverage Type/Amount 29 250 CM O Y 0147/0193 00500 Policy Type/Amount 30 250 CM O 00501 Daily Deductible 31 2 IS O 0223 00755 Living Dependence 32 2 IS O 0009 00145 Ambulatory Status 33 250 CE O 0171 00129 Citizenship 34 250 CE O 0296 00118 Primary Language 35 2 IS O 0220 00742 Living Arrangement 36 250 CE O 0215 00743 Publicity Indicator 37 1 ID O 0136 00744 Protection Indicator 38 2 IS O 0231 00745 Student Indicator 39 250 IS O 0006 00120 Religion 40 250 XPN O Y 00746 Mother s Maiden Name 41 250 CE O 0212 00739 Nationality 42 250 CE O Y 0189 00125 Ethnic Group 43 250 CE O Y 0002 00119 Marital Status 44 8 DT O 00787 Insured s Employment Start Date 45 8 DT O 00783 Insured s Employment Stop Date 46 20 ST O 00785 Job Title 47 20 JCC O 0327/0328 00786 Job Code/Class 48 2 IS O 0311 00752 Job Status 49 250 XPN O Y 00789 Employer Contact Person Name 50 250 XTN O Y 00790 Employer Contact Person Phone Number 51 2 IS O 0222 00791 Employer Contact Reason 52 250 XPN O Y 00792 Insured s Contact Person s Name 53 250 XTN O Y 00793 Insured s Contact Person Telephone Number 54 2 IS O Y 0222 00794 Insured s Contact Person Reason IHS Generic HL7 Message Generator/Filer V 2.0 13 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM ELEMENT NAME IHS File Reference IHS Notes # 55 8 DT O 00795 Relationship To The Patient Start Date 56 8 DT O Y 00796 Relationship To The Patient Stop Date 57 2 IS O 0232 00797 Insurance Co. Contact Reason 58 250 XTN O 00798 Insurance Co Contact Phone Number 59 2 IS O 0312 00799 Policy Scope 60 2 IS O 0313 00800 Policy Source 61 250 CX O 00801 Patient Member Number 62 250 CE O 0063 00802 Guarantor s Relationship To Insured 63 250 XTN O Y 00803 Insured s Telephone Number - Home 64 250 XTN O Y 00804 Insured s Employer Telephone Number 65 250 CE O 0343 00805 Military Handicapped Program 66 1 ID O 0136 00806 Suspend Flag 67 1 ID O 0136 00807 Copay Limit Flag 68 1 ID O 0136 00808 Stoploss Limit Flag 69 250 XON O Y 00809 Insured Organization Name And ID 70 250 XON O Y 00810 Insured Employer Organization Name And ID 71 250 CE O Y 0005 00113 Race 72 250 CE O 0344 00811 HCFA Patient Relationship To Insured IHS Generic HL7 Message Generator/Filer V 2.0 14 July 2001

7.0 6B6BMFA - Master File Acknowledgment (2.4) MFA attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 1 3 ID R 0180 00664 Record-Level Event Code 2 20 ST C 00665 MFN Control ID 3 26 TS O 00668 Event Completion Date/Time 4 250 CE R 0181 00669 Error Return Code And/Or Text 5 250 CE R Y 9999 01308 Primary Key Value MFA 6 3 ID R Y 0355 01320 Primary Key Value Type MFA IHS Generic HL7 Message Generator/Filer V 2.0 15 July 2001

8.0 7B7BMFE - Master File Entry (2.4) MFE attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 1 3 ID R 0180 00664 Record-Level Event Code 2 20 ST C 00665 MFN Control ID 3 26 TS O 00662 Effective Date/Time 4 200 Varie R Y 00667 Primary Key Value - MFE s 5 3 ID R Y 0355 01319 Primary Key Value Type MFE IHS Generic HL7 Message Generator/Filer V 2.0 16 July 2001

9.0 8B8BMFI - Master File Identification (2.4) MFI attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 1 250 CE R 0175 00658 Master File Identifier 2 180 HD O 00659 Master File Application Identifier 3 3 ID R 0178 00660 File-Level Event Code 4 26 TS O 00661 Entered Date/Time 5 26 TS O 00662 Effective Date/Time 6 2 ID R 0179 00663 Response Level Code IHS Generic HL7 Message Generator/Filer V 2.0 17 July 2001

10.0 9B9BMSA - Message Acknowledgment (2.4) The MSA segment contains information sent while acknowledging another message. MSA attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File Reference IHS Notes 1 2 ID R 0008 00018 Acknowledgment Code HL7 Acknowledgement Code - for accept acks 2 20 ST R 00010 Message Control ID echoed back from initial message 3 80 ST O 00020 Text Message may be used for additional information: site-defined 4 15 NM O 00021 Expected Sequence if using HL7 sequence # protocol Number 5 1 ID O 0102 00022 Delayed acknowledgment Type 6 250 CE O 0357 00023 Error Condition may be used for additional information: site-defined IHS Generic HL7 Message Generator/Filer V 2.0 18 July 2001

11.0 10B10BMSH - Message Header (2.4) The MSH segment defines the intent, source, destination, and some specifics of the syntax of a message. MSH attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File IHS Notes Reference 1 1 ST R 00001 Field Separator 2 4 ST R 00002 Encoding Characters ^~\& 3 180 HD O 0361 00003 Sending Application 4 180 HD O 0362 00004 Sending Facility 5 180 HD O 0361 00005 Receiving Application 6 180 HD O 0362 00006 Receiving Facility 7 26 TS O 00007 Date/Time Of Message transaction date/time 8 40 ST O 00008 Security 9 13 CM R 0076/0003 00009 Message Type HL7 Message Type HL7 Event Type Code 10 20 ST R 00010 Message Control ID unique ID for message, echoed back in MSA segment 11 3 PT R 00011 Processing ID usually P 12 60 VID R 0104 00012 Version ID HL7 Version 2.4 13 15 NM O 00013 Sequence Number If using on a broadcast link 14 180 ST O 00014 Continuation Pointer if need to continue message 15 2 ID O 0155 00015 Accept acknowledgment Type HL7 Accept / Application ACK Condition AL 16 2 ID O 0155 00016 Application acknowledgment Type 17 2 ID O 0399 00017 Country Code Country Code - 18 16 ID O Y 0211 00692 Character Set 19 250 CE O 00693 Principal Language Of Message 20 20 ID O 0356 01317 Alternate Character Set Handling Scheme 21 10 ID O Y 0449 01598 Conformance Statement ID IHS Generic HL7 Message Generator/Filer V 2.0 19 July 2001

12.0 1B1BNK1 - Next of Kin / Associated Parties (2.4) The NK1 segment contains information about the patient s other related parties. Any associated parties may be identified. Utilizing the NK1:1 (Set ID) field, multiple NK1 segments can be sent to patient accounts. In the IHS implementation, this segment has a potential of four (4) different uses, based on the values in NK1:3 (Relationship) and NK1:7 (Contact Role). Numbers in the IHS File Reference and IHS Notes columns indicate for which option the field is valued. 1. NK1:3 = self, NK1:7 = : This NK1 will carry the patient s employment status and the patient s employer s name. No other sequence numbers will be used. 2. NK1:3 = spouse, NK1:7 = : This NK1 will carry the patient s spouse s employer s name. No other sequence numbers will be used. 3. NK1:3 = any valid value, NK1:7 = NOK : This NK1 identifies the patient s next-of-kin. NK1:3 identifies the NOK s relationship to the patient (brother, sister, etc), with name, address, and phone number information included in the segment. 4. NK1:3 = any valid value, NK1:7 = EC : This NK1 identifies the patient s emergency contact. NK1:3 identifies the EC s relationship to the patient (brother, sister, etc), with name, address, and phone number information included in the segment. NK1 attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 1 4 SI R 00190 Set ID - Next of Kin / required field, but not really needed: Associated Parties use integer sequence number for # 2 250 XPN Y 00191 Name 3) VA Patient: 2,.211 [next of kin] 4) VA Patient: 2,.331 [emergency contact] NK1 s in the message. 3) name for NOK 4) name for EC IHS Generic HL7 Message Generator/Filer V 2.0 20 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 3 250 CE 0063 00192 Relationship 3) VA Patient: 2,.212 [nok relationship] 4) VA Patient: 2,.332 [ec relationship] used alone to identify self and spouse employer NK1s; used in conjunction with NK1:7 to provide twolevel identification of NOK and EC relationships 1) self (xref: Relationship: 9999999.36,.01) 2) spouse ( ) 3) ptr to Relationship: 9999999.36,.01 [name] 4) ptr to Relationship: 9999999.36,.01 4 250 XAD Y 00193 Address 3) VA Patient: 2,.213,.214,.215 [nok address-street].216 [nok addresscity].217 [nok addressstate].218 [nok addresszip] 4) VA Patient: 2,.333,.334,.335 [ec address-street].336 [ec addresscity].337 [ec addressstate].338 [ec addresszip] [name] 3) next-of-kin address 4) emergency contact address 5 250 XTN Y 00194 Phone Number 3) VA Patient: 2,.219 [nok phone] 4) VA Patient: 2,.339 [ec phone] 6 250 XTN Y 00195 Business Phone Number 7 250 CE 0131 00196 Contact Role Relationship: 9999999.36,.01 [name] - used in conjunction with NK1:3 to provide two-level identification of NOK and EC relationships (See IHS TABLE RELATIONSHIP) 3) NOK 4) EC 8 8 DT 00197 Start Date IHS Generic HL7 Message Generator/Filer V 2.0 21 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 9 8 DT 00198 End Date 10 60 ST 00199 Next of Kin Job Title 11 20 JCC 0327/ 00200 Next of Kin Job 0328 Code/Class 12 250 CX 00201 Next of Kin Employee Number 13 250 XON Y 00202 Organization Name 1) Patient: 9000001,.19 [employer name] 2) Patient: 9000001,.22 [spouse s employer name] 14 250 CE 0002 Marital Status 15 1 IS 0001 Sex 16 26 TS Date of Birth 17 2 ID Y 0223 Living Dependency 18 2 ID Y 0009 Ambulatory Status 19 250 CE Y 0171 Citizenship 20 250 CE 0296 Primary Language 21 2 IS 0220 Living Arrangement 22 250 CE 0215 Publicity Code 23 1 ID 0136 Protection Indicator 24 2 ID 0231 Student Indicator 25 250 ID 0006 Religion 26 250 XPN Y Mother s Maiden Name 27 250 CE 0212 Nationality 28 250 ID Y 0189 Ethnic Group 29 250 CE Y 0222 Contact Reason 30 250 XPN Y Contact Person s Name 31 250 XTN Y Contact Person s Telephone Number 32 250 XAD Y Contact Person s Address 33 250 CX Y Associated Party s Identifiers 34 2 IS 0311 Job Status Code 1) Patient: 9000001,.21 [employment status] 35 250 CE Y 0005 Race 36 2 IS 0295 Handicap Code Cross Reference: HL7 Segments to IHS Files 1) name for patient s employer (relationship = self ) - ptr to Employer: 9999999.75,.01 [employer] 2) name for spouse s employer (relationship = spouse ) - ptr to Employer: 9999999.75,.01 [employer] IHS set: use code and translation (relationship = self ). IHS Generic HL7 Message Generator/Filer V 2.0 22 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 37 16 ST Contact Person Social Security Number * Non-standard datatype and length for this field Cross Reference: HL7 Segments to IHS Files IHS Generic HL7 Message Generator/Filer V 2.0 23 July 2001

13.0 12B12BNTE - Notes and Comments (2.4) The NTE segment is a common format for sending notes and comments. NTE attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File Reference IHS Notes 1 4 SI O 00096 Set ID - Notes and Comments 2 8 ID O 0105 00097 Source of Comment 3 64k FT O Y 00098 Comment 4 250 CE O 0364 01318 Comment Type IHS Generic HL7 Message Generator/Filer V 2.0 24 July 2001

IHS Cross Reference: HL7 Segments to IHS Files 14.0 13B13BOBR - Observation Request (2.4) V Measurement (9000010.01) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. OBR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME0F0F File IHS Notes Reference 1 4 SI O 00237 Set ID - Observation Request 2 22 EI C 00216 Placer Order Number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the V File IEN^Visit Date^MSR, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the 9000010.01^V MEASUREMENT^99IHS^Measureme nt Type^Code 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation Date/Time # See Notes The IHS visit date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST C 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + IHS Generic HL7 Message Generator/Filer V 2.0 25 July 2001

IHS Cross Reference: HL7 Segments to IHS Files SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME0F0F File IHS Notes Reference 22 26 TS C 00255 Results Rpt/Status Chng Should be valued for a corrected report. - Date/Time + 23 40 CM O 00256 Charge to Practice + 24 10 ID C 0074 00257 Diagnostic Serv Sect ID 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector's Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information IHS Generic HL7 Message Generator/Filer V 2.0 26 July 2001

Notes for Element Name Column: Cross Reference: HL7 Segments to IHS Files The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. The starred (*) fields are only relevant when an observation is associated with a specimen. These are completed by the placer when the placer obtains the specimen. They are completed by the filler when the filler obtains the specimen. OBR-7-observation date/time and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case of an observation on a specimen, they represent the start and end of the specimen collector. In the case of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end time of the observation. 9000010.01, V Measurement File. Used for vital signs. OBR:4 = 9000010.01,.01 [type] -> Measurement Type: 9999999.07,.01 [type] and.02 [description] (See chapter 7, Appendix A, AS4- Physical exam codes- vital signs and similar extensions) OBR:7 = 9000010.01,.03 [visit] -> Visit:9000010,.01 [visit / admit date & time] IHS Generic HL7 Message Generator/Filer V 2.0 27 July 2001

15.0 14B14BOBR - Observation Request (2.4) V Eye Glass (9000010.04) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. OBR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME1F1 IHS File IHS Notes Reference 1 4 SI O 00237 Set ID - Observation Request 2 22 EI C 00216 Placer Order Number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the V File IEN^Visit Date^EYE, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the 9000010.04^V EYE GLASS^99IHS 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation Date/Time # See Notes The IHS visit date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST C 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + 22 26 TS C 00255 Results Rpt/Status Chng Should be valued for a corrected report. - Date/Time + 23 40 CM O 00256 Charge to Practice + IHS Generic HL7 Message Generator/Filer V 2.0 28 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME1F1 IHS File IHS Notes Reference 24 10 ID C 0074 00257 Diagnostic Serv Sect ID 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector's Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information Notes for Element Name Column: The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. IHS Generic HL7 Message Generator/Filer V 2.0 29 July 2001

The starred (*) fields are only relevant when an observation is associated with a specimen. These are completed by the placer when the placer obtains the specimen. They are completed by the filler when the filler obtains the specimen. OBR-7-observation date/time and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case of an observation on a specimen, they represent the start and end of the specimen collector. In the case of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end time of the observation. 9000010.04, V Eye Glass File. Used for eyeglass prescription data. OBR:4 = 9000010.04,.01 [name] Create/locate appropriate code [file note: this entry will always be 1 ] OBR:7 = 9000010.04,.03 [visit] -> Visit:9000010,.01 [visit / admit date & time] IHS Generic HL7 Message Generator/Filer V 2.0 30 July 2001

IHS Cross Reference: HL7 Segments to IHS Files 16.0 15B15BOBR - Observation Request (2.4) V Lab (9000010.09) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. OBR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME2F2F File IHS Notes Reference 1 4 SI O 00237 Set ID - Observation Request 2 22 EI C 00216 Placer Order Number This is the accession number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the V File IEN^Visit Date^LAB, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the 9000010.09^V LAB^99IHS^Lab Test^ LAB 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation Date/Time # See Notes The IHS lab collection date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST C 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + 22 26 TS C 00255 Results Rpt/Status Chng Should be valued for a corrected report. - Date/Time + IHS Generic HL7 Message Generator/Filer V 2.0 31 July 2001

IHS Cross Reference: HL7 Segments to IHS Files SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME2F2F File IHS Notes Reference 23 40 CM O 00256 Charge to Practice + 24 10 ID C 0074 00257 Diagnostic Serv Sect ID 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector's Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information Notes for Element Name Column: The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. IHS Generic HL7 Message Generator/Filer V 2.0 32 July 2001

The starred (*) fields are only relevant when an observation is associated with a specimen. These are completed by the placer when the placer obtains the specimen. They are completed by the filler when the filler obtains the specimen. OBR-7-observation date/time and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case of an observation on a specimen, they represent the start and end of the specimen collector. In the case of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end time of the observation. 9000010.09, V Lab File. OBR:2 = 9000010.09, 1102 [order] Construct a valid placer number by concatenating with the visit date, and the universal service identifier to create a unique long term identifier that can serve as the placer number. OBR:4 = 9000010.09,.01 [lab test] -> Laboratory Test: 60. For the first triplet of CE, use 60, 14 -> Procedure Field: 61.5, 2 [snomed code] and.01 [name], with SNM as the code authority; for the second triplet of CE, use 60,.01 [name] and 99IHS as the code authority OBR:8 = 9000010.09, 1201 [collection date and time] OBR:15 = 9000010.09, 1103 [site] -> Topography Field: 61,.01 [name] - Translate into standard HL7 table for specimen source (see section 4.5.1.15) OBR:16 = 9000010.09, 1202 [ordering provider] -> Provider:6,5 [DEA #] and.01 [name] -> Person: 16,.01 [name] IHS Generic HL7 Message Generator/Filer V 2.0 33 July 2001

17.0 16B16BOBR - Observation Request (2.4) V Skin Test (9000010.12) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. OBR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME3F3 IHS File IHS Notes Reference 1 4 SI O 00237 Set ID - Observation Request 2 22 EI C 00216 Placer Order Number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the V File IEN^Visit Date^SK, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the 9000010.12^V SKIN TEST^99IHS^Skin Test Type^Code 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation Date/Time # See Notes The IHS visit date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST C 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + 22 26 TS C 00255 Results Rpt/Status Chng - Date/Time + Should be valued for a corrected report. IHS Generic HL7 Message Generator/Filer V 2.0 34 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME3F3 IHS File IHS Notes Reference 23 40 CM O 00256 Charge to Practice + 24 10 ID C 0074 00257 Diagnostic Serv Sect ID 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector's Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information Notes for Element Name Column: The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. IHS Generic HL7 Message Generator/Filer V 2.0 35 July 2001

The starred (*) fields are only relevant when an observation is associated with a specimen. These are completed by the placer when the placer obtains the specimen. They are completed by the filler when the filler obtains the specimen. OBR-7-observation date/time and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case of an observation on a specimen, they represent the start and end of the specimen collector. In the case of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end time of the observation. 9000010.12, V Skin Test File. Used for Skin test such as TB. OBR:4 = 9000010.12,.01 [skin test] -> Skin Test: 9999999.28,.02 [code] and.01 [name] OBR:7 = 9000010.12, 1201 [event date and time] (when skin test was given ) OBR:8 = 9000010.12,.06 [date read] (when skin test was read ) IHS Generic HL7 Message Generator/Filer V 2.0 36 July 2001

IHS Cross Reference: HL7 Segments to IHS Files 18.0 17B17BOBR - Observation Request (2.4) V Exam File (9000010.13) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. OBR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME4F4F File IHS Notes Reference 1 4 SI O 00237 Set ID - Observation Request 2 22 EI C 00216 Placer Order Number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the V File IEN^Visit Date^XAM, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the 9000010.13^V EXAM^99IHS^Exam Type^Code 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation Date/Time # See Notes The IHS visit date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST C 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + 22 26 TS C 00255 Results Rpt/Status Chng Should be valued for a corrected report. - Date/Time + IHS Generic HL7 Message Generator/Filer V 2.0 37 July 2001

IHS Cross Reference: HL7 Segments to IHS Files SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME4F4F File IHS Notes Reference 23 40 CM O 00256 Charge to Practice + 24 10 ID C 0074 00257 Diagnostic Serv Sect ID 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector's Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information Notes for Element Name Column: The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. IHS Generic HL7 Message Generator/Filer V 2.0 38 July 2001

The starred (*) fields are only relevant when an observation is associated with a specimen. These are completed by the placer when the placer obtains the specimen. They are completed by the filler when the filler obtains the specimen. OBR-7-observation date/time and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case of an observation on a specimen, they represent the start and end of the specimen collector. In the case of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end time of the observation. 9000010.13, V Exam File. OBR:4 = 9000010.13,.01 [exam] -> Exam: 9999999.15,.02 [code] and.01 [name] OBR:7 = 9000010.13,.03 [visit] -> Visit:9000010,.01 [visit / admit date & time] IHS Generic HL7 Message Generator/Filer V 2.0 39 July 2001

19.0 18B18BOBR - Observation Request (2.4) V Treatment (9000010.15) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. OBR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File IHS Notes Reference 1 4 SI O 00237 Set ID - Observation Request 2 22 EI C 00216 Placer Order Number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the Visit IEN^Visit Date^TRT, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the9000010.15^v TREATMENT^99IHS^Treatment Type^Code 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation Date/Time # See Notes The IHS visit date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST C 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + IHS Generic HL7 Message Generator/Filer V 2.0 40 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File IHS Notes Reference 22 26 TS C 00255 Results Rpt/Status Chng Should be valued for a corrected report. - Date/Time + 23 40 CM O 00256 Charge to Practice + 24 10 ID C 0074 00257 Diagnostic Serv Sect ID 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector's Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information IHS Generic HL7 Message Generator/Filer V 2.0 41 July 2001

Notes for Element Name Column: Cross Reference: HL7 Segments to IHS Files The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. The starred (*) fields are only relevant when an observation is associated with a specimen. These are completed by the placer when the placer obtains the specimen. They are completed by the filler when the filler obtains the specimen. OBR-7-observation date/time and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case of an observation on a specimen, they represent the start and end of the specimen collector. In the case of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end time of the observation. 9000010.15, V Treatment File. OBR:4 = 9000010.15,.01 [treatment] -> Treatment: 9999999.17,.02 [code] and.01 [name] OBR:7 = 9000010.15,.03 [visit] -> Visit:9000010,.01 [visit / admit date & time] IHS Generic HL7 Message Generator/Filer V 2.0 42 July 2001

20.0 19B19BOBR - Observation Request (2.4) V Patient Ed (9000010.16) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. OBR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME6F5 IHS File IHS Notes Reference 1 4 SI O 00237 Set ID - Observation Request 2 22 EI C 00216 Placer Order Number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the V File IEN^Visit Date^PED, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the 9000010.16^V Patient Ed^99IHS^Education Topic^Code 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation Date/Time # See Notes The IHS visit date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST C 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + 22 26 TS C 00255 Results Rpt/Status Chng - Date/Time + Should be valued for a corrected report. IHS Generic HL7 Message Generator/Filer V 2.0 43 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME6F5 IHS File IHS Notes Reference 23 40 CM O 00256 Charge to Practice + 24 10 ID C 0074 00257 Diagnostic Serv Sect ID 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector's Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information Notes for Element Name Column: The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. IHS Generic HL7 Message Generator/Filer V 2.0 44 July 2001

The starred (*) fields are only relevant when an observation is associated with a specimen. These are completed by the placer when the placer obtains the specimen. They are completed by the filler when the filler obtains the specimen. OBR-7-observation date/time and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case of an observation on a specimen, they represent the start and end of the specimen collector. In the case of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end time of the observation. 9000010.16, V Patient Ed File. OBR:4 = 9000010.16,.01 [topic] -> Education Topics: 9999999.09,.01 [name] and 1 [mnemonic] OBR:7 = 9000010.16,.03 [visit] -> Visit:9000010,.01 [visit / admit date & time] IHS Generic HL7 Message Generator/Filer V 2.0 45 July 2001

21.0 20B20BOBR - Observation Request (2.4) V Physical Therapy (9000010.17) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. OBR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME7F6 IHS File IHS Notes Reference 1 4 SI O 00237 Set ID - Observation Request 2 22 EI C 00216 Placer Order Number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the V File IEN^Visit Date^PT, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the 9000010.17^V PHYSICAL THERAPY^99IHS^PT Code^PT Name 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation Date/Time # See Notes The IHS visit date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST C 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + 22 26 TS C 00255 Results Rpt/Status Chng - Date/Time + Should be valued for a corrected report. IHS Generic HL7 Message Generator/Filer V 2.0 46 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME7F6 IHS File IHS Notes Reference 23 40 CM O 00256 Charge to Practice + 24 10 ID C 0074 00257 Diagnostic Serv Sect ID 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector's Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information Notes for Element Name Column: The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. IHS Generic HL7 Message Generator/Filer V 2.0 47 July 2001

The starred (*) fields are only relevant when an observation is associated with a specimen. These are completed by the placer when the placer obtains the specimen. They are completed by the filler when the filler obtains the specimen. OBR-7-observation date/time and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case of an observation on a specimen, they represent the start and end of the specimen collector. In the case of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end time of the observation. 9000010.17, V Physical Therapy File. OBR:4 = 9000010.17,.01 [code] -> Physical Therapy: 9999999.46,.02 [CPT code] and.01 [PT treatment] OBR:7 = 9000010.17,.03 [visit] -> Visit:9000010,.01 [visit / admit date & time] IHS Generic HL7 Message Generator/Filer V 2.0 48 July 2001

IHS Cross Reference: HL7 Segments to IHS Files 22.0 21B21BOBR - Observation Request (2.4) V CPT (9000010.18) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. OBR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME8F7F File IHS Notes Reference 1 4 SI O 00237 Set ID - Observation Request 2 22 EI C 00216 Placer Order Number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the V File IEN^Visit Date^CPT, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the 9000010.18^V CPT^99IHS^CPT Code^CPT Desc 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation Date/Time # See Notes The IHS visit date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST C 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + 22 26 TS C 00255 Results Rpt/Status Chng Should be valued for a corrected report. - Date/Time + IHS Generic HL7 Message Generator/Filer V 2.0 49 July 2001

IHS Cross Reference: HL7 Segments to IHS Files SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME8F7F File IHS Notes Reference 23 40 CM O 00256 Charge to Practice + 24 10 ID C 0074 00257 Diagnostic Serv Sect ID 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector's Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information Notes for Element Name Column: The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. IHS Generic HL7 Message Generator/Filer V 2.0 50 July 2001

The starred (*) fields are only relevant when an observation is associated with a specimen. These are completed by the placer when the placer obtains the specimen. They are completed by the filler when the filler obtains the specimen. OBR-7-observation date/time and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case of an observation on a specimen, they represent the start and end of the specimen collector. In the case of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end time of the observation. 9000010.18, V CPT File. OBR:4 = 9000010.18,.01 [CPT] -> CPT: 81,.01 [CPT code] and 2 [short name] OBR:16 = 9000010.18, 1202 [ordering provider] -> Provider: 6, 5 [DEA#] and.01 [name] -> Person: 16,.01 [name] IHS Generic HL7 Message Generator/Filer V 2.0 51 July 2001

23.0 2B2BOBR - Observation Request (2.4) V Diagnostic Procedure (9000010.21) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. OBR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File IHS Notes Reference 1 4 SI O 00237 Set ID - Observation Request 2 22 EI C 00216 Placer Order Number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the V File IEN^Visit Date^DXP, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the 9000010.21^V DIAGNOSTIC PROCEDURE^99IHS^Diagnostic Procedure^Code 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation Date/Time # See Notes The IHS visit date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST C 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + IHS Generic HL7 Message Generator/Filer V 2.0 52 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File IHS Notes Reference 22 26 TS C 00255 Results Rpt/Status Chng Should be valued for a corrected report. - Date/Time + 23 40 CM O 00256 Charge to Practice + 24 10 ID C 0074 00257 Diagnostic Serv Sect ID 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector's Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information IHS Generic HL7 Message Generator/Filer V 2.0 53 July 2001

Notes for Element Name Column: Cross Reference: HL7 Segments to IHS Files The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. The starred (*) fields are only relevant when an observation is associated with a specimen. These are completed by the placer when the placer obtains the specimen. They are completed by the filler when the filler obtains the specimen. OBR-7-observation date/time and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case of an observation on a specimen, they represent the start and end of the specimen collector. In the case of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end time of the observation. 9000010.21, V Diagnostic Procedure Result File. OBR:4 = 9000010.21,.01 [type] -> Diagnostic Procedure Result: 9999999.68,.01 [result] (use as description - there is no corresponding code) OBR:16 = 9000010.21, 1202 [ordering provider] -> Provider: 6, 5 [DEA#] and.01 [name] -> Person: 16,.01 [name] IHS Generic HL7 Message Generator/Filer V 2.0 54 July 2001

IHS Cross Reference: HL7 Segments to IHS Files 24.0 23B23BOBR - Observation Request (2.4) V Radiology (9000010.22) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. OBR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME10F9 File IHS Notes Reference 1 4 SI O 00237 Set ID - Observation Request 2 22 EI C 00216 Placer Order Number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the V File IEN^Visit Date^RAD, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the 9000010.22^V RADIOLOGY^99IHS^Impression^Code 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation Date/Time # See Notes The IHS visit date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collector Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Code 13 300 ST C 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + 22 26 TS C 00255 Results Rpt/Status Chng Should be valued for a corrected report. - Date/Time + IHS Generic HL7 Message Generator/Filer V 2.0 55 July 2001

IHS Cross Reference: HL7 Segments to IHS Files SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME10F9 File IHS Notes Reference 23 40 CM O 00256 Charge to Practice + 24 10 ID C 0074 00257 Diagnostic Serv Sect ID 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers * 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector's Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0224 01032 Transport Arranged 42 1 ID O 0225 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental Service Information 47 250 CE O Y 0411 01475 Filler Supplemental Service Information Notes for Element Name Column: The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. IHS Generic HL7 Message Generator/Filer V 2.0 56 July 2001

The starred (*) fields are only relevant when an observation is associated with a specimen. These are completed by the placer when the placer obtains the specimen. They are completed by the filler when the filler obtains the specimen. OBR-7-observation date/time and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case of an observation on a specimen, they represent the start and end of the specimen collector. In the case of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end time of the observation. 9000010.22, V Radiology File. OBR:4 = 9000010.22,.01 [radiology procedure] -> Radiology Procedures: 71, 9 [CPT code] and.01 [name] OBR:16 = 9000010.22, 1202 [ordering provider] -> Provider: 6, 5 [DEA#] and.01 [name] -> Person: 16,.01 [name] IHS Generic HL7 Message Generator/Filer V 2.0 57 July 2001

25.0 24B24BOBR Observation Request (2.4) V Health Factors (9000010.23) The OBR (Observation Request) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment. It defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations, vital signs or physical exam. SEQ LEN DT R/O RP# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 1 4 SI O 00237 Set ID Observation Request 2 22 EI C 00213 Place Order Number 3 22 EI C 00217 Filler Order Number + This is generated by concatenating the V File IEN^Visit Date^HF, See IHS TABLE FILLER ORDER NUMBER IDENTIFIER) 4 250 CE R 00238 Universal Service ID See Notes This is generated by concatenating the 9000010.23^V HEALTH FACTORS^99IHS^Health Factor^Code 5 2 ID X 00239 Priority 6 26 TS X 00240 Requested Date/time 7 26 TS C 00241 Observation End Date # See Notes The IHS visit date/time 8 26 TS O 00242 Observation End Date/Time # 9 20 CQ O 00243 Collection Volume * 10 250 XCN O Y 00244 Collection Identifier * 11 1 ID O 0065 00245 Specimen Action Code * 12 250 CE O 00246 Danger Coe 13 250 CE O 00247 Relevant Clinical Info. 14 26 TS C 00248 Specimen Received Date/Time * 15 300 CM O 0070 00249 Specimen Source * 16 250 XCN O Y 00226 Ordering Provider See Notes 17 250 XTN O Y/2 00250 Order Callback Phone Number 18 60 ST O 00251 Placer field 1 19 60 ST O 00252 Placer field 2 20 60 ST O 00253 Filler Field 1 + 21 60 ST O 00254 Filler Field 2 + 22 26 TX C 00255 Results Rpt/Status Chng Should be valued for a corrected report Date/Time + 23 40 CM O 00256 Charge to Practice + 24 10 ID C 0074 00257 Diagnostic SErv Sect ID IHS Generic HL7 Message Generator/Filer V 2.0 58 July 2001

SEQ LEN DT R/O RP# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 25 1 ID C 0123 00258 Result Status + Assumed to be= F for final, or C for corrected (see OBR:22) 26 400 CM O 00259 Parent Result + 27 200 TQ O Y 00221 Quantity/Timing 28 250 XCN O Y/5 00260 Result Copies To 29 200 CM O 00261 Parent Number + 30 20 ID O 0124 00262 Transportation Mode 31 250 CE O Y 00263 Reason for Study 32 200 CM O 00264 Principal Result Interpreter + 33 200 CM O Y 00265 Assistant Result Interpreter + 34 200 CM O Y 00266 Technician + 35 200 CM O Y 00267 Transcriptionist + 36 26 TS O 00268 Scheduled Date/Time + 37 4 NM O 01028 Number of Sample Containers + 38 250 CE O Y 01029 Transport Logistics of Collected Sample * 39 250 CE O Y 01030 Collector s Comment * 40 250 CE O 01031 Transport Arrangement Responsibility 41 30 ID O 0244 01032 Transport Arranged 42 1 ID O 0255 01033 Escort Required 43 250 CE O Y 01034 Planned Patient Transport Comment 44 250 CE O Y 0088 00393 Procedure Code 45 250 CE O Y 0340 01316 Procedure Code Modifier 46 250 CE O Y 0411 01474 Placer Supplemental 47 250 CE O Y 0411 01475 Filler Supplemental Service Information Notes for Element Name Column: The daggered (+) items in this segment are not created by the placer. They are created by the filler and valued as needed when the OBR segment is returned as part of a report. Hence on a new order sent to the filler, they are not valued. There is an exception when the filler initiates the order. In that case, the filler order number is valued and the placer order number may be blank. The starred (*) fields are only relevant when an observation is associated with a specimen. These are completed by the placer when the placer obtains the specimen. They are completed by the filler when the filler obtains the specimen. IHS Generic HL7 Message Generator/Filer V 2.0 59 July 2001

OBR-7-observation date/time and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case of an observation on a specimen, they represent the start and end of the specimen collector. In the case of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end time of the observation. 9000010.23, V Health Factors File. OBR:4 = 9000010.23,.01 [health factor] -> Health Factors: 9999999.64,.02 [code] and.01 [factor] OBR:7 = 9000010.23,.03 [visit] -> Visit:9000010,.01 [visit / admit date & time] IHS Generic HL7 Message Generator/Filer V 2.0 60 July 2001

26.0 25B25BOBX - Observation / Result (2.4) V Measurement (9000010.01) The OBX segment is used to transmit a single observation or observation fragment. It represents the smallest indivisible unit of a report. OBX attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 1 10 SI O 00569 Set ID - Observational Simple 2 2 ID R 0125 00570 Value Type See Notes ST 3 250 CE R 00571 Observation Identifier See Notes Measurement Type^Type Description^99IHS 4 20 ST C 00572 Observation Sub-ID Measurement Type 5 64k * C Y ** 00573 Observation Value See Notes Value (.04) 6 250 CE O 00574 Units See Notes Observation units. 7 60 ST O 00575 References Range See Notes 8 5 ID O Y/5 0078 00576 Abnormal Flags See Notes 9 5 NM O 00577 Probability 10 2 ID O Y 0080 00578 Nature of Abnormal Test 11 1 ID R 0085 00579 Observ Result Status 12 26 TS O 00580 Date Last Obs Normal Values 13 20 ST O 00581 User Defined Access Checks 14 26 TS O 00582 Date/Time of the See Notes Observation 15 250 CE O 00583 Producer's ID 16 250 XCN O Y 00584 Responsible Observer See Notes 17 250 CE O Y 00936 Observation Method 18 22 EI O Y 01479 Equipment Instance Identifier 19 26 TS O 01480 Date/Time of the Analysis ** May repeat for CE, TX, and FT data types. 9000010.01, V Measurement File. Used for vital signs. OBX:2 = ST IHS Generic HL7 Message Generator/Filer V 2.0 61 July 2001

OBX:3 = 9000010.01,.01 [type] -> Measurement Type: 9999999.07,.01 [type] and.02 [description] (use same CE value as OBR:4, since this is a single point measurement) OBX:4 = 9000010.01,.01 [type] -> Measurement Type: 9999999.07,.01 [type] OBX:5 = 9000010.01,.04 [value] IHS Generic HL7 Message Generator/Filer V 2.0 62 July 2001

27.0 26B26BOBX - Observation / Result (2.4) V Eye Glass (9000010.04) The OBX segment is used to transmit a single observation or observation fragment. It represents the smallest indivisible unit of a report. OBX attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 1 10 SI O 00569 Set ID - Observational Simple 2 2 ID R 0125 00570 Value Type See Notes Varies dependant on OBX (ID, ST, NM) 3 250 CE R 00571 Observation Identifier See Notes V Eye Field #^V Eye Field Name^99IHS 4 20 ST C 00572 Observation Sub-ID This is the name of the.01 field from the OBR seg 5 64k * C Y ** 00573 Observation Value See Notes This is the observation value. See Appendix 6 250 CE O 00574 Units See Notes Observation units. 7 60 ST O 00575 References Range See Notes 8 5 ID O Y/5 0078 00576 Abnormal Flags See Notes 9 5 NM O 00577 Probability 10 2 ID O Y 0080 00578 Nature of Abnormal Test 11 1 ID R 0085 00579 Observ Result Status 12 26 TS O 00580 Date Last Obs Normal Values 13 20 ST O 00581 User Defined Access Checks 14 26 TS O 00582 Date/Time of the See Notes Observation 15 250 CE O 00583 Producer's ID 16 250 XCN O Y 00584 Responsible Observer See Notes 17 250 CE O Y 00936 Observation Method 18 22 EI O Y 01479 Equipment Instance Identifier 19 26 TS O 01480 Date/Time of the Analysis ** May repeat for CE, TX, and FT data types. 9000010.04, V Eye Glass File. Used for eyeglass prescription data. Each file entry will require 14 OBX segments as follows: IHS Generic HL7 Message Generator/Filer V 2.0 63 July 2001

1901: Reading Only OBX:2 = ID OBX:3 = 1901^READING ONLY^99IHS OBX:5 = 9000010.04, 1901 [reading only]: Y:YES, N:NO (HL7 Table 0136) 1902: DRE sphere OBX:2 = ST OBX:3 = 1902^DRE SPHERE^99IHS OBX:5 = 9000010.04, 1902 [dre sphere] 1903: DRE cylinder OBX:2 = NM OBX:3 = 1903^DRE CYLINDER^99IHS OBX:5 = 9000010.04, 1903 [dre cylinder] 1904: RE axis OBX:2 = NM OBX:3 = 1904^RE AXIS^99IHS OBX:5 = 9000010.04, 1904 [re axis] 1905: DLE sphere OBX:2 = ST OBX:3 = 1905^DLE SPHERE^99IHS OBX:5 = 9000010.04, 1905 [dle sphere] 1906: DLE cylinder OBX:2 = NM IHS Generic HL7 Message Generator/Filer V 2.0 64 July 2001

OBX:3 = 1906^DLE CYLINDER^99IHS Cross Reference: HL7 Segments to IHS Files OBX:5 = 9000010.04, 1906 [dle cylinder] 1907: LE axis OBX:2 = NM OBX:3 = 1907^LE AXIS^99IHS OBX:5 = 9000010.04, 1907 [le axis] 1908: Reading Add. R. OBX:2 = NM OBX:3 = 1908^READING ADD. R.^99IHS OBX:5 = 9000010.04, 1908 [reading add. r.] 1909: Reading Add. L. OBX:2 = NM OBX:3 = 1909^READING ADD. R.^99IHS OBX:5 = 9000010.04, 1909 [reading add. l.] 1910: Eye Size OBX:2 = NM OBX:3 = 1910^EYE SIZE^99IHS OBX:5 = 9000010.04, 1910 [eye size] 1911: Bridge OBX:2 = NM OBX:3 = 1911^BRIDGE^99IHS IHS Generic HL7 Message Generator/Filer V 2.0 65 July 2001

OBX:5 = 9000010.04, 1911 [bridge] Cross Reference: HL7 Segments to IHS Files 1912: Temple OBX:2 = NM OBX:3 = 1912^TEMPLE^99IHS OBX:5 = 9000010.04, 1912 [temple] 1913: Pup. Dist. Near OBX:2 = NM OBX:3 = 1913^PUP. DIST. NEAR^99IHS OBX:5 = 9000010.04, 1913 [pup. dist. near] 1914: Pup. Dist. Far OBX:2 = NM OBX:3 = 1914^PUP. DIST. FAR^99IHS OBX:5 = 9000010.04, 1914 [pup. dist. far] IHS Generic HL7 Message Generator/Filer V 2.0 66 July 2001

28.0 27B27BOBX - Observation / Result (2.4) V Lab (9000010.09) The OBX segment is used to transmit a single observation or observation fragment. It represents the smallest indivisible unit of a report. OBX attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 1 10 SI O 00569 Set ID - Observational Simple 2 2 ID R 0125 00570 Value Type See Notes ST 3 250 CE R 00571 Observation Identifier See Notes Snomed Code^Snomed Name^SNM^Lab Test^^99IHS 4 20 ST C 00572 Observation Sub-ID Laboratory Test 5 64k * C Y ** 00573 Observation Value See Notes This is the observation value. 6 250 CE O 00574 Units See Notes Observation units. 7 60 ST O 00575 References Range See Notes Reference Low and High 8 5 ID O Y/5 0078 00576 Abnormal Flags See Notes Y/N 9 5 NM O 00577 Probability 10 2 ID O Y 0080 00578 Nature of Abnormal Test 11 1 ID R 0085 00579 Observ Result Status 12 26 TS O 00580 Date Last Obs Normal Values 13 20 ST O 00581 User Defined Access Checks 14 26 TS O 00582 Date/Time of the See Notes Observation 15 250 CE O 00583 Producer's ID 16 250 XCN O Y 00584 Responsible Observer See Notes 17 250 CE O Y 00936 Observation Method 18 22 EI O Y 01479 Equipment Instance Identifier 19 26 TS O 01480 Date/Time of the Analysis ** May repeat for CE, TX, and FT data types. 9000010.09, V Lab File. OBX:2 = ST IHS Generic HL7 Message Generator/Filer V 2.0 67 July 2001

OBX:3 = 9000010.09,.01 [lab test] -> Laboratory Test: 60. For the first triplet of CE, use 60, 14 -> Procedure Field: 61.5, 2 [snomed code] and.01 [name], with SNM as the code authority; for the second triplet of CE, use 60,.01 [name] and 99IHS as the code authority. (Same as OBR:4 for single lab test.) OBX:4 = Laboratory Test -> 60 ->.01 OBX:5 = 9000010.09,.04 [results] OBX:6 = 9000010.09, 1101 [units] Translate IHS values to use standard HL7 table of units, see Ch. 7, section 7.1.4, and 7.1.4.2, and 7.3.2.6. OBX:7 = 9000010.09, 1104 [reference low] and 1105 [reference high] OBX:8 = 9000010.09.05 [abnormal] Use standard HL7 table for this field, see Ch. 7., 7.3.2.8 IHS Generic HL7 Message Generator/Filer V 2.0 68 July 2001

29.0 28B28BOBX - Observation / Result (2.4) V Skin Test (9000010.12) The OBX segment is used to transmit a single observation or observation fragment. It represents the smallest indivisible unit of a report. OBX attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 1 10 SI O 00569 Set ID - Observational Simple 2 2 ID R 0125 00570 Value Type See Notes Either CE OR NM, dependant on field passed 3 250 CE R 00571 Observation Identifier See Notes Either.04^RESULTS^99IHS or.05^reading^99ihs 4 20 ST C 00572 Observation Sub-ID Skin Test 5 64k * C Y ** 00573 Observation Value See Notes Either Results (.04) or Reading (.05) 6 250 CE O 00574 Units See Notes Observation units. 7 60 ST O 00575 References Range See Notes 8 5 ID O Y/5 0078 00576 Abnormal Flags See Notes 9 5 NM O 00577 Probability 10 2 ID O Y 0080 00578 Nature of Abnormal Test 11 1 ID R 0085 00579 Observ Result Status 12 26 TS O 00580 Date Last Obs Normal Values 13 20 ST O 00581 User Defined Access Checks 14 26 TS O 00582 Date/Time of the See Notes Observation 15 250 CE O 00583 Producer's ID 16 250 XCN O Y 00584 Responsible Observer See Notes 17 250 CE O Y 00936 Observation Method 18 22 EI O Y 01479 Equipment Instance Identifier 19 26 TS O 01480 Date/Time of the Analysis ** May repeat for CE, TX, and FT data types. 9000010.12, V Skin Test File. Used for Skin test such as TB. Each file entry will require two OBX segments as follows: IHS Generic HL7 Message Generator/Filer V 2.0 69 July 2001

04: Results OBX:2 = CE OBX:3 =.04^RESULTS^99IHS OBX:4 = Skin Test -> 9999999.28 ->.01 OBX:5 = 9000010.12,.04 [results]: IHS set: use code and translation 05: Reading OBX:2 = NM OBX:3 =.05^READING^99IHS OBX:4 = Skin Test -> 9999999.28 ->.01 OBX:5 = 9000010.12,.05 [reading] IHS Generic HL7 Message Generator/Filer V 2.0 70 July 2001

30.0 29B29BOBX - Observation / Result (2.4) V Exam (9000010.13) The OBX segment is used to transmit a single observation or observation fragment. It represents the smallest indivisible unit of a report. OBX attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 1 10 SI O 00569 Set ID - Observational Simple 2 2 ID R 0125 00570 Value Type See Notes CE 3 250 CE R 00571 Observation Identifier See Notes.04^RESULTS^99IHS 4 20 ST C 00572 Observation Sub-ID Exam 5 64k * C Y ** 00573 Observation Value See Notes Results (.04) 6 250 CE O 00574 Units See Notes Observation units. 7 60 ST O 00575 References Range See Notes 8 5 ID O Y/5 0078 00576 Abnormal Flags See Notes 9 5 NM O 00577 Probability 10 2 ID O Y 0080 00578 Nature of Abnormal Test 11 1 ID R 0085 00579 Observ Result Status 12 26 TS O 00580 Date Last Obs Normal Values 13 20 ST O 00581 User Defined Access Checks 14 26 TS O 00582 Date/Time of the See Notes Observation 15 250 CE O 00583 Producer's ID 16 250 XCN O Y 00584 Responsible Observer See Notes 17 250 CE O Y 00936 Observation Method 18 22 EI O Y 01479 Equipment Instance Identifier 19 26 TS O 01480 Date/Time of the Analysis ** May repeat for CE, TX, and FT data types. 9000010.13, V Exam File. OBX:2 = CE OBX:3 =.04^RESULTS^99IHS IHS Generic HL7 Message Generator/Filer V 2.0 71 July 2001

OBX:4 = Exam -> 9999999.15 ->.01 Cross Reference: HL7 Segments to IHS Files OBX:5 = 9000010.13,.04 [results]: IHS set: use code and translation IHS Generic HL7 Message Generator/Filer V 2.0 72 July 2001

31.0 30B30BOBX - Observation / Result (2.4) V Treatment (9000010.15) The OBX segment is used to transmit a single observation or observation fragment. It represents the smallest indivisible unit of a report. OBX attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 1 10 SI O 00569 Set ID - Observational Simple 2 2 ID R 0125 00570 Value Type See Notes NM 3 250 CE R 00571 Observation Identifier See Notes.04^HOW MANY^99IHS 4 20 ST C 00572 Observation Sub-ID Treatment 5 64k * C Y ** 00573 Observation Value See Notes How Many (.04) 6 250 CE O 00574 Units See Notes Observation units. 7 60 ST O 00575 References Range See Notes 8 5 ID O Y/5 0078 00576 Abnormal Flags See Notes 9 5 NM O 00577 Probability 10 2 ID O Y 0080 00578 Nature of Abnormal Test 11 1 ID R 0085 00579 Observ Result Status 12 26 TS O 00580 Date Last Obs Normal Values 13 20 ST O 00581 User Defined Access Checks 14 26 TS O 00582 Date/Time of the See Notes Observation 15 250 CE O 00583 Producer's ID 16 250 XCN O Y 00584 Responsible Observer See Notes Provider DEA^Provider Name 17 250 CE O Y 00936 Observation Method 18 22 EI O Y 01479 Equipment Instance Identifier 19 26 TS O 01480 Date/Time of the Analysis ** May repeat for CE, TX, and FT data types. 9000010.15, V Treatment File. OBX:2 = NM OBX:3 =.04^HOW MANY^99IHS IHS Generic HL7 Message Generator/Filer V 2.0 73 July 2001

OBX:4 = Treatment -> 9999999.17 ->.01 Cross Reference: HL7 Segments to IHS Files OBX:5 = 9000010.15,.04 [how many] OBX:16 = 9000010.15,.05 [provider] -> Provider: 6, 5 [DEA #] and.01 [name] -> Person: 16,.01 [name] IHS Generic HL7 Message Generator/Filer V 2.0 74 July 2001

32.0 31B31BOBX - Observation / Result (2.4) V Patient Ed (9000010.16) The OBX segment is used to transmit a single observation or observation fragment. It represents the smallest indivisible unit of a report. OBX attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 1 10 SI O 00569 Set ID - Observational Simple 2 2 ID R 0125 00570 Value Type See Notes CE 3 250 CE R 00571 Observation Identifier See Notes.06^LEVEL OF UNDERSTANDING^99IHS 4 20 ST C 00572 Observation Sub-ID Education Topics 5 64k * C Y ** 00573 Observation Value See Notes Level of Understanding (.06 ) 6 250 CE O 00574 Units See Notes Observation units. 7 60 ST O 00575 References Range See Notes 8 5 ID O Y/5 0078 00576 Abnormal Flags See Notes 9 5 NM O 00577 Probability 10 2 ID O Y 0080 00578 Nature of Abnormal Test 11 1 ID R 0085 00579 Observ Result Status 12 26 TS O 00580 Date Last Obs Normal Values 13 20 ST O 00581 User Defined Access Checks 14 26 TS O 00582 Date/Time of the See Notes Observation 15 250 CE O 00583 Producer's ID 16 250 XCN O Y 00584 Responsible Observer See Notes Provider DEA^Provider Name 17 250 CE O Y 00936 Observation Method 18 22 EI O Y 01479 Equipment Instance Identifier 19 26 TS O 01480 Date/Time of the Analysis ** May repeat for CE, TX, and FT data types. 9000010.16, V Patient Ed File. OBX:2 = CE OBX:3 =.06^LEVEL OF UNDERSTANDING^99IHS IHS Generic HL7 Message Generator/Filer V 2.0 75 July 2001

OBX:4 = Education Topics -> 9999999.09 ->.01 Cross Reference: HL7 Segments to IHS Files OBX:5 = 9000010.16,.06 [level of understanding]: IHS set: use code and translation OBX:16 = 9000010.16,.05 [provider] -> Provider: 6, 5 [DEA #] and.01 [name] -> Person: 16,.01 [name] IHS Generic HL7 Message Generator/Filer V 2.0 76 July 2001

33.0 32B32BOBX - Observation / Result (2.4) V Physical Therapy (9000010.17) The OBX segment is used to transmit a single observation or observation fragment. It represents the smallest indivisible unit of a report. OBX attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 1 10 SI O 00569 Set ID - Observational Simple 2 2 ID R 0125 00570 Value Type See Notes NM 3 250 CE R 00571 Observation Identifier See Notes.04^Quantity^99IHS 4 20 ST C 00572 Observation Sub-ID Physical Therapy 5 64k * C Y ** 00573 Observation Value See Notes Quantity (.04) 6 250 CE O 00574 Units See Notes Observation units. 7 60 ST O 00575 References Range See Notes 8 5 ID O Y/5 0078 00576 Abnormal Flags See Notes 9 5 NM O 00577 Probability 10 2 ID O Y 0080 00578 Nature of Abnormal Test 11 1 ID R 0085 00579 Observ Result Status 12 26 TS O 00580 Date Last Obs Normal Values 13 20 ST O 00581 User Defined Access Checks 14 26 TS O 00582 Date/Time of the See Notes Observation 15 250 CE O 00583 Producer's ID 16 250 XCN O Y 00584 Responsible Observer See Notes 17 250 CE O Y 00936 Observation Method 18 22 EI O Y 01479 Equipment Instance Identifier 19 26 TS O 01480 Date/Time of the Analysis ** May repeat for CE, TX, and FT data types. 9000010.17, V Physical Therapy File. OBX:2 = NM OBX:3 =.04^QUANTITY^99IHS IHS Generic HL7 Message Generator/Filer V 2.0 77 July 2001

OBX:4 = Physical Therapy -> 9999999.46 ->.01 Cross Reference: HL7 Segments to IHS Files OBX:5 = 9000010.17,.04 [quantity] IHS Generic HL7 Message Generator/Filer V 2.0 78 July 2001

34.0 3B3BOBX - Observation / Result (2.4) V CPT (9000010.18) The OBX segment is used to transmit a single observation or observation fragment. It represents the smallest indivisible unit of a report. OBX attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 1 10 SI O 00569 Set ID - Observational Simple 2 2 ID R 0125 00570 Value Type See Notes NM 3 250 CE R 00571 Observation Identifier See Notes.05^UNITS^99IHS 4 20 ST C 00572 Observation Sub-ID CPT Code 5 64k * C Y ** 00573 Observation Value See Notes Units 6 250 CE O 00574 Units See Notes Observation units. 7 60 ST O 00575 References Range See Notes 8 5 ID O Y/5 0078 00576 Abnormal Flags See Notes 9 5 NM O 00577 Probability 10 2 ID O Y 0080 00578 Nature of Abnormal Test 11 1 ID R 0085 00579 Observ Result Status 12 26 TS O 00580 Date Last Obs Normal Values 13 20 ST O 00581 User Defined Access Checks 14 26 TS O 00582 Date/Time of the See Notes Observation 15 250 CE O 00583 Producer's ID 16 250 XCN O Y 00584 Responsible Observer See Notes 17 250 CE O Y 00936 Observation Method 18 22 EI O Y 01479 Equipment Instance Identifier 19 26 TS O 01480 Date/Time of the Analysis ** May repeat for CE, TX, and FT data types. 9000010.18, V CPT File. OBX:2 = NM OBX:3 =.05^UNITS^99IHS IHS Generic HL7 Message Generator/Filer V 2.0 79 July 2001

OBX:4 = CPT -> 81 ->.01 Cross Reference: HL7 Segments to IHS Files OBX:5 = 9000010.18,.05 [units] IHS Generic HL7 Message Generator/Filer V 2.0 80 July 2001

35.0 34B34BOBX - Observation / Result (2.4) V Diagnostic Procedure (9000010.21) The OBX segment is used to transmit a single observation or observation fragment. It represents the smallest indivisible unit of a report. OBX attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 1 10 SI O 00569 Set ID - Observational Simple 2 2 ID R 0125 00570 Value Type See Notes TX 3 250 CE R 00571 Observation Identifier See Notes Either.04^VALUE^99IHS or.06^params^99ihs 4 20 ST C 00572 Observation Sub-ID Diagnostic Procedure Result 5 64k * C Y ** 00573 Observation Value See Notes Either Value (.04) or Params (.06) 6 250 CE O 00574 Units See Notes Observation units. 7 60 ST O 00575 References Range See Notes 8 5 ID O Y/5 0078 00576 Abnormal Flags See Notes 9 5 NM O 00577 Probability 10 2 ID O Y 0080 00578 Nature of Abnormal Test 11 1 ID R 0085 00579 Observ Result Status 12 26 TS O 00580 Date Last Obs Normal Values 13 20 ST O 00581 User Defined Access Checks 14 26 TS O 00582 Date/Time of the See Notes Event Date/Time Observation 15 250 CE O 00583 Producer's ID 16 250 XCN O Y 00584 Responsible Observer See Notes 17 250 CE O Y 00936 Observation Method 18 22 EI O Y 01479 Equipment Instance Identifier 19 26 TS O 01480 Date/Time of the Analysis IHS Generic HL7 Message Generator/Filer V 2.0 81 July 2001

** May repeat for CE, TX, and FT data types. Cross Reference: HL7 Segments to IHS Files 9000010.21, V Diagnostic Procedure Result File. Each file entry will require two OBX segments as follows:.04: Value OBX:2 = TX OBX:3 =.04^VALUE^99IHS OBX:4 = Diagnostic Procedure Result -> 9999999.68 ->.01 OBX:5 = 9000010.21,.04 [value] OBX:8 = 9000010.21,.05 [abnormal] Use HL7 standard table values if possible for this field OBX:14 = 9000010.21, 1201 [event date & time].06: Params OBX:2 = TX OBX:3 =.06^PARAMS^99IHS OBX:4 = Diagnostic Procedure Result -> 9999999.68 ->.01 OBX:5 = 9000010.21,.06 [params] OBX:14 = 9000010.21, 1201 [event date & time] IHS Generic HL7 Message Generator/Filer V 2.0 82 July 2001

36.0 35B35BOBX - Observation / Result (2.4) V Radiology (9000010.22) The OBX segment is used to transmit a single observation or observation fragment. It represents the smallest indivisible unit of a report. OBX attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 1 10 SI O 00569 Set ID - Observational Simple 2 2 ID R 0125 00570 Value Type See Notes TX 3 250 CE R 00571 Observation Identifier See Notes 1101^IMPRESSION^99IHS 4 20 ST C 00572 Observation Sub-ID Radiology Procedure 5 64k * C Y ** 00573 Observation Value See Notes Impression (1101) 6 250 CE O 00574 Units See Notes Observation units. 7 60 ST O 00575 References Range See Notes 8 5 ID O Y/5 0078 00576 Abnormal Flags See Notes Diagnostic Code (.05) 9 5 NM O 00577 Probability 10 2 ID O Y 0080 00578 Nature of Abnormal Test 11 1 ID R 0085 00579 Observ Result Status 12 26 TS O 00580 Date Last Obs Normal Values 13 20 ST O 00581 User Defined Access Checks 14 26 TS O 00582 Date/Time of the See Notes Event Date/Time (1201) Observation 15 250 CE O 00583 Producer's ID 16 250 XCN O Y 00584 Responsible Observer See Notes 17 250 CE O Y 00936 Observation Method 18 22 EI O Y 01479 Equipment Instance Identifier 19 26 TS O 01480 Date/Time of the Analysis ** May repeat for CE, TX, and FT data types. 9000010.22, V Radiology File. OBX:2 = TX OBX:3 = 1101^IMPRESSION^99IHS IHS Generic HL7 Message Generator/Filer V 2.0 83 July 2001

OBX:4 = Radiology Procedure -> 71 ->.01 Cross Reference: HL7 Segments to IHS Files OBX:5 = 9000010.22, 1101 [impression] OBX:8 = 9000010.22,.05 [diagnostic code] Use HL7 standard table values if possible for this field OBX:14 = 9000010.22, 1201 [event date & time] IHS Generic HL7 Message Generator/Filer V 2.0 84 July 2001

37.0 36B36BOBX - Observation / Result (2.4) V Health Factors (9000010.23) The OBX segment is used to transmit a single observation or observation fragment. It represents the smallest indivisible unit of a report. OBX attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 1 10 SI O 00569 Set ID - Observational Simple 2 2 ID R 0125 00570 Value Type See Notes Either TX or NM 3 250 CE R 00571 Observation Identifier See Notes Either.04^LEVEL/SEVERITY^99IHS or.06^quantity^99ihs 4 20 ST C 00572 Observation Sub-ID Health Factors (.01) 5 64k * C Y ** 00573 Observation Value See Notes Either Level/Severity (.04) or Quantity (.06) 6 250 CE O 00574 Units See Notes Observation units. 7 60 ST O 00575 References Range See Notes 8 5 ID O Y/5 0078 00576 Abnormal Flags See Notes 9 5 NM O 00577 Probability 10 2 ID O Y 0080 00578 Nature of Abnormal Test 11 1 ID R 0085 00579 Observ Result Status 12 26 TS O 00580 Date Last Obs Normal Values 13 20 ST O 00581 User Defined Access Checks 14 26 TS O 00582 Date/Time of the See Notes Observation 15 250 CE O 00583 Producer's ID 16 250 XCN O Y 00584 Responsible Observer See Notes 17 250 CE O Y 00936 Observation Method 18 22 EI O Y 01479 Equipment Instance Identifier 19 26 TS O 01480 Date/Time of the Analysis IHS Generic HL7 Message Generator/Filer V 2.0 85 July 2001

** May repeat for CE, TX, and FT data types. Cross Reference: HL7 Segments to IHS Files 9000010.23, V Health Factors File. Each file entry will require two OBX segments as follows:.04: Level/Severity OBX:2 = TX OBX:3 =.04^LEVEL / SEVERITY^99IHS OBX:4 = Health Factors -> 9999999.64 ->.01 OBX:5 = 9000010.23,.04 [level / severity]: IHS set: use code and translation.06: Quantity OBX:2 = NM OBX:3 =.06^QUANTITY^99IHS OBX:4 = Health Factors -> 9999999.64 ->.01 OBX:5 = 9000010.23,.06 [quantity] IHS Generic HL7 Message Generator/Filer V 2.0 86 July 2001

38.0 37B37BORC - Common Order (2.4) The ORC (Common Order) segment is used to transmit fields that are common to all orders (all types of services that are requested). If details are needed for a particular type of order (e.g., Pharmacy), the ORC must precede any order detail segment (e.g., RXD). ORC attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 1 2 ID R 0119 00215 Order Control NW for RDS normal message, DC if RDS discontinue message (see ORC:15) 2 22 EI C 00216 Placer Order Number 3 22 EI C 00217 Filler Order Number This will be the same format as the OBR filler order number 4 22 EI O 00218 Placer Group Number 5 2 ID O 0038 00219 Order Status 6 1 ID O 0121 00220 Response Flag 7 200 TQ O Y 00221 Quantity/Timing See Notes 8 200 CM O 00222 Parent 9 26 TS O 00223 Date/Time of Transaction 10 250 XCN O Y 00224 Entered By 11 250 XCN O Y 00225 Verified By 12 250 XCN O Y 00226 Ordering Provider See Notes 13 80 PL O 00227 Enterer's Location 14 40 XTN O Y/2 00228 Call Back Phone Number 15 26 TS O 00229 Order Effective See Notes See Also ORC:1 Date/Time 16 250 CE O 00230 Order Control Code Reason 17 250 CE O 00231 Entering Organization 18 250 CE O 00232 Entering Device 19 250 XCN O 00233 Action By 20 250 CE O 0339 01310 Advanced Beneficiary Notice 21 250 XON O Y 01311 Ordering Facility Name 22 250 XAD O Y 01312 Ordering Facility Address 23 250 XTN O Y 01313 Ordering Facility Phone Number 24 250 XAD O Y 01314 Ordering Provider Address IHS Generic HL7 Message Generator/Filer V 2.0 87 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference 25 250 CWE O N 01473 Order Status Modifier IHS Notes 9000010.14, V Medication File. For each data point in the file, we will use the following values from the ORC segment. 9000010.14,.05: SIG ORC:7 -- Use 2nd component, Interval, for SIG or 8th component for free text version of SIG, depending on which is most appropriate. 9000010.06: Quantity ORC:7 -- Use first component for quantity 9000010.14,.07: Days Prescribed ORC:7 -- Use third component, duration, for days prescribed 9000010.14, 1202: Ordering Provider ORC:12 -- 9000010.04, 1202, Ordering Provider -> Provider: 6,5 [DEA#], and.01 [name] -> Person: 16,.01 [name] 9000010.14,.08: Date Discontinued ORC:15 -- Order Effective Date /Time -- use only with order control code of DC, i.e., if medication has been discontinued IHS Generic HL7 Message Generator/Filer V 2.0 88 July 2001

39.0 38B38BPD1 - Patient Demographic (2.4) The patient demographic segment contains demographic information that is likely to change about the patient. PD1 attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT IHS File Reference IHS Notes NAME 1 2 IS O Y 0223 00755 Living Dependency 2 2 IS O 0220 00742 Living Arrangement 3 250 XON O Y 00756 Patient Primary Facility 4 250 XCN O Y 00757 Patient Primary Care Provider Patient: 9000001,.14 [designated provider] ptr to Provider: 6, 5 [DEA #] and.01 [name] -> Person: 16,.01 [name] Name & ID No. 5 2 IS O 0231 00745 Student Indicator 6 2 IS O 0295 00753 Handicap 7 2 IS O 0315 00759 Living Will 8 2 IS O 0316 00760 Organ Donor 9 1 ID O 0136 00761 Separate Bill 10 250 CX O Y 00762 Duplicate Patient 11 250 CE O 0215 00763 Publicity Code 12 1 ID O 0136 00744 Protection Indicator 13 8 DT O 01566 Protection Indicator Effective Date 14 250 XON O Y 01567 Place of Worship 15 250 CE O Y 0435 01548 Advance Directive Code 16 1 IS O 0441 01569 Immunization Registry Status 17 8 DT O 01570 Immunization Registry Status Effective Date 18 8 DT O 01571 Publicity Code Effective Date 19 5 IS O 0140 01572 Military Branch 20 2 IS O 0141 00486 Military Rank/Grade 21 3 IS O 0142 00487 Military Status IHS Generic HL7 Message Generator/Filer V 2.0 89 July 2001

40.0 39B39BPID - Patient Identification (2.4) The PID segment is used by all applications as the primary means of communicating patient identification information. This segment contains permanent patient identifying and demographic information that, for the most part, is not likely to change frequently. PID attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 1 4 SI 00104 Set ID - Patient ID 2 20 CX B 00105 Patient ID (External ID) 3 250 CX R Y 00106 Patient ID (Internal ID) ASUFAC and Sending Facility HRCN ASUFAC_HRCN^^^^domain^D NS 4 20 CX B Y 00107 Alternate Patient ID All other HRCNS ASUFAC_HRCN^^^^domain^D NS^rep 5 250 XPN R Y 00108 Patient Name VA Patient: 2,.01 [name] 6 250 XPN Y 00109 Mother's Maiden Name VA Patient: 2,.2403 [mother s maiden name] Note that in HL7 this is just a string datatype (not complete PN datatype). 7 26 TS 00110 Date of Birth VA Patient: 2,.03 [dob] Convert to HL7 date format 8 1 IS 0001 00111 Administrative Sex VA Patient: 2,.02 [sex] Convert IHS to standard HL7 values for this table 9 250 XPN Y 00112 Patient Alias Patient: 9000001, 4601.2 [other name] 10 250 CE Y 0005 00113 Race 11 250 XAD Y 00114 Patient Address VA Patient: 2,.111,.112,.113 [mailing add.-street].114 [mailing add.-city].115 [mailing add.-state].116 [mailing add.-zip] 12 4 IS B 0289 00115 County Code VA Patient: 2,.117 13 250 XTN Y 00116 Phone Number - Home VA Patient: 2,.131 [home phone] 14 250 XTN Y 00117 Phone Number - VA Patient: 2,.132 [office 0 Business phone] 15 250 CE 0296 00118 Language - Patient 16 250 CE 0002 00119 Marital Status 17 250 CE 0006 00120 Religion VA Patient: 2,.08 [religion] See IHS TABLE RELIGION. 18 250 CX 00121 Patient Account Number. 19 16 ST B 00122 SSN Number - Patient VA Patient: 2,.09 [ssn] 20 25 DLN 00123 Driver's Lic Num - Patient IHS Generic HL7 Message Generator/Filer V 2.0 90 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 21 250 CX Y 00124 Mother's Identifier 22 250 CE Y 0189 00125 Ethnic Group 23 250 ST 00126 Birth Place : see ZP1:13 24 1 ID 0136 00127 Multiple Birth Indicator 25 2 NM 00128 Birth Order 26 250 CE Y 0171 00129 Citizenship 27 250 CE 0172 00130 Veterans Military Status VA Patient: 2, 1901 [veteran (y/n)?] Y:YES, N:NO (use HL7 yes/no table #0136) 28 250 CE 0212 00739 Nationality Code 29 26 TS 00740 Patient Death Date and Time Patient: 9000001, 1113.2 [date of death] Note: in HL7 this is a timestamp datatype, rather than a simple date. If this field is valued, it implies that the next field is set = Y 30 1 ID 0136 00741 Patient Death Indicator See note to previous field. 31 1 ID 0136 01535 Identity Unknown Indicator 32 20 IS Y 0445 01536 Identity Reliability Code 33 26 TS 01537 Last Update/Time 34 40 HD 01538 Last Update Facility 35 250 CE 0446 01539 Species Code 36 250 CE 0447 01540 Breed Code 37 80 ST 01541 Strain 38 250 CE 0429 01542 Production Class Code * Non-standard Datatype for this field IHS Generic HL7 Message Generator/Filer V 2.0 91 July 2001

41.0 40B40BPR1 Procedures (2.4) The PR1 segment contains information relative to various types of procedures that can be performed on a patient. For example: Surgical, Nuclear Medicine, X-Ray with contrast, etc. The PR1 segment is used to send multiple procedures, for example, for medical records encoding or for billing systems. In the IHS implementation, each PR1 is followed by one ZPR. PR1 attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference 1 4 SI R 00391 Set ID - Procedure 2 3 IS R 0089 00392 Procedure Coding Method 3 250 CE R 0088 00393 Procedure Code Visit: 9000010,.17 [evaluation & management] V Dental: 9000010.05,.01 [service code] V Procedure: 9000010.08,.01 [procedure] 4 40 ST B 00394 Procedure Description 5 26 TS R 00395 Procedure Date/Time V Procedure: 9000010.08,.06 [procedure date] 6 2 IS R 0230 00396 Procedure Functional Type 7 4 NM O 00397 Procedure Minutes 8 250 XCN B Y 0010 00398 Anesthesiologist V Procedure: 9000010.08,.12 [anesthesiologist] 9 2 IS O 0019 00399 Anesthesia Code 10 4 NM O 00400 Anesthesia Minutes V Procedure: 9000010.08,.13 [elapsed time (anesthesia)] 11 250 XCN B Y 0010 00401 Surgeon V Provider: 9000010.06,.01 V Procedure: 9000010.08,.11 Operating provider IHS Notes ptr to CPT: 81,.01 [cpt code] and 3 [short name] ptr to ADA Code: 9999999.31,.01 [code] and.02 [description] ptr to ICD Operation / Procedure: 80.1,.01 [code number] and 4 [operation/procedure]: all fields referenced to V Procedure file below (PR1, ZPR) refer to this procedure. ptr to Provider: 6, 5 [DEA #] and.01 [name] -> Person: 16,.01 [name] anesthesia time for this surgical procedure Use if V Provider File, 9000010.06.05= O. For this surgical procedure ptr to Provider: 6, 5 [DEA #] and.01 [name] -> Person: 16,.01 [name] IHS Generic HL7 Message Generator/Filer V 2.0 92 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference 12 250 XCN B Y 0010 00402 Procedure V Provider: 9000010.06,.01 Practitioner 13 250 CE O 0059 00403 Consent Code 14 2 NM O 00404 Procedure Priority V Procedure: 9000010.08,.07 [principle procedure] 15 250 CE O 0051 00772 Associated V Procedure: 9000010.08, Diagnosis Code.05 [diagnosis] 16 250 CE O Y 0340 01316 Procedure Code Modifier 17 20 IS O 0416 01501 Procedure DRG Type 18 250 CE O Y 0417 01502 Tissue Type Code IHS Notes What are conditions in V Provider File, fileds.04 and.05 for use of this field? Translate IHS set values to HL7 set values. ptr to ICD Diagnosis: 80,.01 [code number] and 3 [diagnosis] IHS Generic HL7 Message Generator/Filer V 2.0 93 July 2001

42.0 41B41BPV1 - Patient Visit (2.4) The PV1 segment is used by Registration/ADT applications to communicate information on a visit-specific basis. This segment can be used to send multiple-visit statistic records to the same patient account, or single-visit records to more than one account. Individual sites must determine the use for this segment. In the IHS implementation, each PV1 segment by one ZV1 segment. PV1 attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT IHS File Reference IHS Notes NAME 1 4 SI O 00131 Set ID Patient Visit 2 1 IS R 0004 00132 Patient Class 3 80 PL O 00133 Assigned Patient Location Visit: 9000010,.06 [loc. of encounter].08 [clinic stop] ptr to Clinic Stop: 40.7,.01 [name] ptr to Location: 9999999.06,.01 [name]-> Institution: 4,.01 [name] if PCC 4 2 IS O 0007 00134 Admission Type V Hosp.: 9000010.02,.07 [admission type] or ptr to Ward^Room/Bed (.06^.07) of 405 if ADT 2.3.1 PL datatype supports both inpatient and outpatient location file entries. Location^Clinic (Ward for Inpatient) ptr to Admission Type: 405.1, 9999999.01 [IHS code] and.01 [name] if PCC or ptr to Type of Movement (.04) of 405 if ADT 5 250 CX O 00135 Preadmit Number Not used 6 80 PL O 00136 Prior Patient Location Ward^Room^Bed before transfer IHS Generic HL7 Message Generator/Filer V 2.0 94 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference 7 250 XCN O Y 0010 00137 Attending Doctor * V Provider: 9000010.06,.01 [provider] IHS Notes ptr to Provider: 6, 5 [DEA #] and.01 [name] -> Person: 16,.01 [name] V Provider: 9000010.06,.04= P, 9000010.06,.05= A if PCC 8 250 XCN O Y 0010 00138 Referring Doctor 9 250 XCN B Y 0010 00139 Consulting Doctor V Provider: 9000010.06,.01 [provider] Or ptr to Attending Physician (.19) of 405 if ADT Note: may be non-physician provider. ptr to Provider: 6, 5 [DEA #] and.01 [name] -> Person: 16,.01 [name] V Provider: 9000010.06,.04= S V Provider: 9000010.06,.05= A or O Note: may be non-physician providers; repeating field may carry all three values. 10 3 IS O 0069 00140 Hospital Service Visit: 9000010,.07 [service category] IHS set: use code and translation (See IHS TABLE SERVICE CATEGORY) 11 80 PL O 00141 Temporary Location 12 2 IS O 0087 00142 Preadmit Test Indicator 13 2 IS O 0092 00143 Readmission Indicator 14 6 IS O 0023 00144 Admit Source 15 2 IS O Y 0009 00145 Ambulatory Status 16 2 IS O 0099 00146 VIP Indicator 17 250 XCN O Y 0010 00147 Admitting Doctor Ptr to Admitting Physician (.08) of 405 for ADT 18 2 IS O 0018 00148 Patient Type 19 250 CX O 00149 Visit Number Contains the visit IEN 20 50 FC O Y 0064 00150 Financial Class Visit: 9000010,.03 [type] IHS set: use code and translation in first component (See IHS TABLE VISIT TYPE) 21 2 IS O 0032 00151 Charge Price Indicator 22 2 IS O 0045 00152 Courtesy Code 23 2 IS O 0046 00153 Credit Rating 24 2 IS O Y 0044 00154 Contract Code 25 8 DT O Y 00155 Contract Effective Date 26 12 NM O Y 00156 Contract Amount IHS Generic HL7 Message Generator/Filer V 2.0 95 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT IHS File Reference IHS Notes NAME 27 3 NM O Y 00157 Contract Period 28 2 IS O 0073 00158 Interest Code 29 1 IS O 0110 00159 Transfer to Bad Debt Code 30 8 DT O 00160 Transfer to Bad Debt Date 31 10 IS O 0021 00161 Bad Debt Agency Code 32 12 NM O 00162 Bad Debt Transfer Amount 33 12 NM O 00163 Bad Debt Recovery Amount 34 1 IS O 0111 00164 Delete Account Indicator 35 8 DT O 00165 Delete Account Date 36 3 IS O 0112 00166 Discharge Disposition V Hosp.: 9000010.02,.06 [discharge type] ptr to Discharge Type: 405.1, 9999999.01 [IHS code] and.01 [name] 37 25 CM O 0113 00167 Discharged to Location V Hosp.: 9000010.02,.09 [transferred to] 38 250 CE O 0114 00168 Diet Type 39 2 IS O 0115 00169 Servicing Facility 40 1 IS B 0116 00170 Bed Status 41 2 IS O 0117 00171 Account Status 42 80 PL O 00172 Pending Location 43 80 PL O 00173 Prior Temporary Location 44 26 TS O 00174 Admit Date/Time Visit: 9000010,.01 [visit / admit date & time] 45 26 TS O 00175 Discharge Date/Time Visit: 9000010,.18 [check out date & time] or V. Hosp.: 9000010.02,.01 [date of discharge] variable ptr: Institution: 4,.01 [name] or Vendor: 9999999.11,.01 [name] Since IHS uses possibility of 2 tables here, could promote data type from CM to CE or PL so that codes will not overlap (only needed if code+name needs to be transmitted). [Requires minor site-defined negotiation.] Use for inpatient stay or appointment start date/time. Use for inpatient stay or appointment end date/time. For discharge date, time may be included (see HL7 TS datatype) IHS Generic HL7 Message Generator/Filer V 2.0 96 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT IHS File Reference IHS Notes NAME 46 12 NM O 00176 Current Patient Balance 47 12 NM O 00177 Total Charges 48 12 NM O 00178 Total Adjustments 49 12 NM O 00179 Total Payments 50 250 CX O 0203 00180 Alternate Visit ID 51 1 IS O 0326 01226 Visit Indicator 52 250 XCN B Y 0010 01224 Other Healthcare Provider Cross Reference: HL7 Segments to IHS Files * For incoming transactions, a value in the PV1:7 field (Attending Doctor) will be placed in the.01 field and will cause a computed value of P to be placed in the.04 field and a computed value of A to be placed in the.05 field. A value in the PV1:9 field (Consulting Doctor) will be placed in the.01 field and will cause a computed value of S to be placed in the.04 field; the.05 field will be left blank. For outgoing transactions, a value of P in the.04 field and a value of A in the.05 field will cause the.01 field (Provider) to be placed in the PV1:7 field. Any other combination of values in the.04 and.05 fields will cause the.01 field to be placed in the PV1:9 field. The V Provider file does not distinguish between physicians and other types of providers (RNs, pharmacists, etc). Therefore, the provider in any given instance may or may not be a physician. # Non-standard data type for this sequence number. IHS Generic HL7 Message Generator/Filer V 2.0 97 July 2001

43.0 42B42BQAK Query Acknowledgement (QAK) (2.4) The QAK segment is used to send information with responses to a query. QAK attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File Reference IHS Notes 1 32 ST C 00696 Query Tag 2 2 ID O 0208 00708 Query Response Status 3 250 CE O 01375 Message Query Name 4 10 NM O 01434 Hit Count 5 10 NM O 01622 This Payload 6 10 NM O 01623 Hits Remaining IHS Generic HL7 Message Generator/Filer V 2.0 98 July 2001

44.0 43B43BQRD Query Definition (2.4) The QRD segment is used to define a query. See CDC Specification for detailed information on IHS use for immunizations. QRD attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 1 26 TS R 00025 Query Date/Time Same as MSH Date/Time 2 1 ID R 0106 00026 Query Format Code 3 1 ID R 0091 00027 Query Priority 4 10 ST R 00028 Query ID 5 1 ID O 0107 00029 Deferred Response Type 6 26 TS O 00030 Deferred Response Date/Time 7 10 CQ R 0126 00031 Quantity Limited Request 8 250 XCN R Y 00032 Who Subject Filter 9 250 CE R Y 0048 00033 What Subject Filter 10 250 CE R Y 00034 What Department Data Code 11 20 CM O 00035 What Data Code Value Qual 12 1 ID O 0108 00036 Query Results Level IHS Generic HL7 Message Generator/Filer V 2.0 99 July 2001

45.0 4B4BQRF Query Filter (2.4) The QRF segment is used with the QRD segment to further refine the query. QRF attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File IHS Notes Reference 1 20 ST R Y 00037 Where Subject Filter 2 26 TS O 00038 When Data Start Date/Time 3 26 TS O 00039 When Data End Date/Time 4 60 ST O Y 00040 What User Qualifier 5 60 ST O Y 00041 Other QRY Subject Filter See CDC Specification for Immunization Message Details. 6 12 ID O Y 0156 00042 Which Date/Time Qualifier 7 12 ID O Y 0157 00043 Which Date/Time Status Qual 8 12 ID O Y 0158 00044 Date/Time Selection Qualifier 9 60 TQ O 00694 When Quantity/Timing Qualifier 10 10 NM O 01442 Search Confidence Threshold IHS Generic HL7 Message Generator/Filer V 2.0 100 July 2001

46.0 45B45BRXA - Pharmacy / Treatment Administration (2.4) The RXA carries the administration data for a pharmacy administration message. The accompanying ORC must have the filler order number and the order control code RE. Note: use HL7 2.3.1 chapter 4, appendix 4B for definition of administration messages (unsolicited and queries). Use this document for segment and field specifications for the RXA segment. In the IHS implementation, each RXA segment is followed by one ZRA segment. RXA attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File Reference IHS Notes 1 4 NM R 00342 Give Sub-ID Counter 2 4 NM R 00344 Administration Sub- ID Counter 3 26 TS R 00345 Date/Time Start of Administration V Immunization: 9000010.11,.03 [visit] 4 26 TS R 00346 Date/Time End of Administration 5 250 CE R 0292 00347 Administered Code V Immunization: 9000010.11,.01 [immunization] 6 20 NM R 00348 Administered Amount 7 250 CE C 00349 Administered Units 8 250 CE O 00350 Administered Dosage Form 9 250 CE C Y 00351 Administration Notes 10 250 XCN O Y 00352 Administering Provider 11 200 CM C 00353 Administered-at Location 12 20 ST C 00354 Administered Per (Time Unit) 13 20 NM O 01134 Administered Strength 14 250 CE O 01135 Administered Strength Units ptr to Visit: 9000010,.01 [visit / admit date & time] ptr to Immunization: 9999999.14,.03 [code] and.01 [name] ^CVX IHS Generic HL7 Message Generator/Filer V 2.0 101 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File Reference IHS Notes 15 20 ST O Y 01129 Substance Lot Number V Immunization: 9000010.11,.05 [lot] 16 26 TS O Y 01130 Substance Expiration Date 17 250 CE O Y 0227 01131 Substance Manufacturer Name 18 250 CE O Y 01136 Substance Refusal Reason 19 250 CE O Y 01123 Indication 20 2 ID O 0322 01223 Completion Status 21 2 ID O 0323 01224 Action Code Cross Reference: HL7 Segments to IHS Files ptr to Immunization Lot: 9999999.41,.01 [lot number] indirect from V Immunization through Immunization Lot to IMM Manufacturer: 9999999.04,.01 [name] IHS Generic HL7 Message Generator/Filer V 2.0 102 July 2001

47.0 46B46BRXD - Pharmacy / Treatment Dispense (2.4) The RXD segment carries the dispense data for a given issuance of medication; thus it may describe a single dose, a half-day dose, a daily dose, a refill of a prescription, etc. The RXD is not a complete record of an order. It is a record from the pharmacy or treatment supplier to the Nursing (or other) application with drug/treatment dispense and administration instructions. The accompanying ORC must have the filler order number and the order control code NW, RP, or DC. RXD attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File Reference IHS Notes 1 4 NM R 00334 Dispense Sub-ID Counter 2 250 CE R 00335 Dispense/Give Code V Medication: 9000010.14,.01 [medication].04 [name of non-table drug] 3 26 TS R 00336 Date/Time Dispensed V Medication: 9000010.14, 1201 [event date and time] 4 20 NM R 00337 Actual Dispense V Medication: 9000010.14, Amount.06 [quantity] 5 250 CE C 00338 Actual Dispense Units 6 250 CE O 00339 Actual Dosage Form 7 20 ST R 00325 Prescription Number 8 20 NM C 00326 Number of Refills Remaining 9 200 ST O Y 00340 Dispense Notes 10 200 XCN O Y 00341 Dispensing Provider 11 1 ID O 0167 00342 Substitution Status 12 10 CQ O 00328 Total Daily Dose 13 200 CM C 00299 Dispense-to Location 14 1 ID O 0136 00307 Needs Human Review 15 250 CE O Y 00330 Pharmacy/Treatment Supplier Special Dispensing Instructions 16 20 NM O 01132 Actual Strength 17 250 CE O 01133 Actual Strength Unit 18 20 ST O Y 01129 Substance Lot Number 19 26 TS O Y 01130 Substance Expiration Date (1st triplet) ptr to Drug: 50,.01 [generic name] (2nd triplet)^non Drug Name^99IHS for dispense/fill date/time Duplicates value from first subcomponent of first component of quantity/timing field of ORC. IHS Generic HL7 Message Generator/Filer V 2.0 103 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File Reference IHS Notes 20 250 CE O Y 0227 01131 Substance Manufacturer Name 21 250 CE O Y 01123 Indication 22 20 NM O 01220 Dispense Package Size 23 250 CE O 01221 Dispense Package Size Unit 24 2 ID O 0321 01222 Dispense Package Method 25 250 CE O Y 01476 Supplementary Code 26 250 CE O 01477 Initiating Location 27 250 CE O 01478 Packaging/Assembly Location Cross Reference: HL7 Segments to IHS Files IHS Generic HL7 Message Generator/Filer V 2.0 104 July 2001

48.0 47B47BRXR Pharmacy/Treatment Route (2.4) The Pharmacy/Treatment route segment contains the alternative combination of route, site, administration device, and administration method that are prescribed. RXR attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File Reference IHS Notes 1 250 CE R 0162 00309 Route 2 250 CE O 0163 00310 Site 3 250 CE O 0164 00311 Administration Device 4 250 CE O 0165 00312 Administration Method 5 250 CE O 01315 Routing Instruction IHS Generic HL7 Message Generator/Filer V 2.0 105 July 2001

49.0 48B48BZDX - IHS Diagnosis Extension (2.4) The ZDX segment is used by IHS to transmit additional diagnosis information that is not contained in any HL7-standard segment. The ZDX is used in conjunction with the DG1; with each DG1 followed by one ZDX. ZDX attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT IHS File Reference IHS Notes NAME 1 80 ST R Provider Narrative V POV: 9000010.07,.04 ptr to Provider Narrative: 9999999.27,.01 [narrative] 2 1 NM O Stage V POV: 9000010.07,.05 3 60 CE O Modifier V POV: 9000010.07,.06 IHS set: use code and translation 4 60 CE O Cause of DX V POV: 9000010.07,.07 IHS set: use code and translation 5 60 CE O First/Revisit V POV: 9000010.07,.08 IHS set: use code and translation 6 80 CE O Cause of Injury V POV: 9000010.07,.09 ptr to ICD Diagnosis: 80,.01 [code number] and 3 [diagnosis] If this field is related to the POV DX in the DG1 segment it needs to be here. If unrelated, it can be part of the DG1 segment (with a new DX type). IHS Generic HL7 Message Generator/Filer V 2.0 106 July 2001

50.0 49B49BZFD IHS Drug File Update (2.4) The ZFD segment is used by IHS to transmit via a Master File Notification, information about a drug that has been updated on the RPMS system. ZFD attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 1 40 ST R Generic Name Drug: 50,.01 2 11 ID O Y Warning Label Drug: 50, 8 3 3 NM O Maximum Dose Per Day Drug: 50, 4 4 1 ID R DEA Schedule Drug: 50, 3 Internal Value 5 60 ST O Standard SIG Drug: 50, 5 6 3 ID R Order Unit Drug: 50, 12 7 10 MO R Price Per Order Unit Drug: 50, 12 8 10 ST R Dispense Unit Drug: 50, 14.5 9 10 MO R Price Per Dispense Unit Drug: 50, 16 10 5 NM R Dispense Units Per Drug: 50, 15 Order Unit 11 1 ID R Non-Formulary Drug: 50, 51 Internal Value 12 8 DT C Inactive Date Drug: 50, 100 13 68 ST O Message Drug: 50, 101 14 1 ID O Chemotherapy Drug Drug: 50, 202 Internal Value IHS Generic HL7 Message Generator/Filer V 2.0 107 July 2001

51.0 50B50BZP1 - IHS Patient Information: Health Record Identifiers (2.4) (Obsolete, Now in PID-3) The ZP1 segment is used by IHS to transmit information about a patient s health records. It repeats as necessary to completely define the patient s health record information. It is used with all IHS supported events. ZP2 attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 1 6 NM R Health Record Number Patient: 9000001.41,.02 [health record number] 2 80 CE R Health Record Facility Patient: 9000001.41,.01 [health record facility] 3 8 DT O Date Inactivated/Deleted Patient: 9000001.41,.03 4 60 ST O Record Disposition Patient: 9000001.41,.04 ptr to Patient Record Disposition: 9999999.02,.01 [description] 5 60 CE O Record Status Patient: 9000001.41,.05 IHS set: use code and translation IHS Generic HL7 Message Generator/Filer V 2.0 108 July 2001

52.0 51B51BZP2 - IHS Patient Information (2.4) The ZP2 segment is used by IHS to transmit permanent patient identifying and demographic information that is not included in any of the HL7-standard segments. ZP2 attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 1 8 DT R Date Established Patient: 9000001,.02 2 8 DT R Date of last Reg Patient: 9000001,.03 Update 3 8 DT R Med/RR Release Patient: 9000001,.04 Date 4 8 DT R Med/RR Release Patient: 9000001,.05 Revoked Date 5 60 CE R Tribal Enrollment Number Patient: 9000001,.07 Number^ Tribal Enrollment Number ^Tribe.IHS.GOV 6 60 CE R CHS Tribal Affiliation Patient: 9000001,.09 ptr to Tribe: 9999999.03,.02 [code] and.01 [name] 7 3 ID O Blood Type Patient: 9000001,.13 IHS set: use code only 8 8 DT R Date of last update Patient: 9000001,.16 9 8 DT O Assign Benefits Patient: 9000001,.17 Obtained Date 10 8 DT O Assign Benefits Patient: 9000001,.18 Expired Date 11 60 CE O SSN Verification Status Patient: 9000001,.23 ptr to SSN Status: 9999999.78,.01 [code] and.02 [description] 12 60 CE O Reason for no SSN Patient: 9000001,.24 IHS set: use code and translation 13 40 AD O Birth Place Patient: 9000001, 1103.2 [city of birth] 1104.2 [state of birth] 14 6 ST O Birth Certificate No. Patient: 9000001, 1105 15 60 CE R Tribe of membership Patient: 9000001, 1108 ptr to Tribe: 9999999.03,.02 [code] and.01 [name] 16 12 ST O Tribe quantum Patient: 9000001, 1109 17 12 ST R Indian blood Patient: 9000001, 1110 quantum 18 60 CE R Classification/Benefi ciary Patient: 9000001, 1111 ptr to Beneficiary: 9999999.25,.02 [code] and.01 [name] 19 8 DT O Current residence date Patient: 9000001, 1113 IHS Generic HL7 Message Generator/Filer V 2.0 109 July 2001

SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 20 2 ID O State of Death Patient: 9000001, 1115 ptr to State: 5, 1 [abbreviation] 21 6 ST O Death Certificate Patient: 9000001, 1116 Number 22 60 ST O Current Community Patient: 9000001, 1117 ptr to Community: 9999999.05,.01 [name] 23 60 CE O Tribe Membership Patient: 9000001, 1119 IHS set: use code and translation Verified Flag 24 1 ID O Residence Verified Flag Patient: 9000001, 1121 Y:YES, N:NO (use HL7 yes/no table #0136) 25 8 DT O Date Eligibility Patient: 9000001, 1123 determined 26 60 CE O Eligible Minor Child Patient: 9000001, 1125 IHS set: use code and translation 27 10K TX O Y Location of Home Patient: 9000001, 1201 Not Supported 28 10K TX O Y Additional Patient: 9000001, 1301 Not Supported Registration Info 29 10K TX O Y Remarks Patient: 9000001, 1401 Not Supported 30 10K TX O Y Alerts Patient: 9000001, 1501 Not Supported 31 48 PN O Father s Name VA Patient: 2, 2401 32 40 AD O Father s Birth Place Patient: 9000001, 2602 [father s city of birth] ptr to State: 5, 1 [abbreviation] 2603 [father s state of birth] 33 40 AD O Mother s Birth Place Patient: 9000001, 2605 [mother s city of birth] 2606 [mother s state of birth] ptr to State: 5, 1 [abbreviation] IHS Generic HL7 Message Generator/Filer V 2.0 110 July 2001

53.0 52B52BZP3 - IHS Patient Information: Other Tribes (2.4) The ZP3 segment is used by IHS to transmit information contained in a patient s records about membership in additional tribes. The ZP3 segment will repeat as necessary to transmit all the additional tribes the patient is affiliated with. ZP3 attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME 1 60 CE R Other tribe (tribe ID and name) 2 12 ST R Other tribe, quantum IHS File Reference Patient: 9000001.43,.01 Patient: 9000001.43,.02 IHS Notes ptr to Tribe: 9999999.03,.02 [code] and.01 [name] IHS Generic HL7 Message Generator/Filer V 2.0 111 July 2001

54.0 53B53BZP4 - IHS Patient Information: Previous Community (2.4) The ZP4 segment is used by IHS to transmit information about any previous communities in which the patient may have lived. The ZP4 segment will repeat as necessary to transmit all the communities on record. ZP4 attributes SEQ LEN DT R/O RP/# TBL# ITEM ELEMENT NAME IHS File Reference IHS Notes # 1 60 CE R Previous Community Patient: 9000001.51,.03 [community of residence] ptr to Community: 9999999.05, 8801 [code] and.01 [name] 2 8 DT R Date Moved Patient: 9000001.51,.01 3 8 DT R Date Added to File Patient: 9000001.51,.02 IHS Generic HL7 Message Generator/Filer V 2.0 112 July 2001

55.0 54B54BZPR - IHS Procedure Extension (2.4) The ZPR segment is used by IHS to transmit additional information about dental and/or surgical procedures that is not contained in any of the HL7-standard segments. One ZPR is used in conjunction with each PR1 segment. ZPR attributes SEQ LEN DT R/O RP/# TBL ITEM ELEMENT NAME IHS File Reference IHS Notes # # 1 2 NM R No. of Units V Dental: 9000010.05,.04 Use with PR1 for ADA code for V. Dental File 2 60 CE O Operative site V Dental: 9000010.05,.05 ptr to Dental Operative Site: 9002010.03, 8801 [mnemonic] and.01 [anatomic name] 3 5 ST O Tooth Surface V Dental: 9000010.05,.06 4 80 ST R Provider Narrative V Procedure: 9000010.08,.04 ptr to Provider Narrative: 9999999.27,.01 [narrative] 5 1 ID O Infection V Procedure: 9000010.08,.08 Y:YES, N:NO (use HL7 yes/no table #0136) 6 1 ID O Anesthesia administered V Procedure: 9000010.08,.14 1:YES, 0:NO (translate to/from HL7 yes/no table #0136) 7 60 CE O ASA-PS class V Procedure: 9000010.08, ptr to ASA-PS Code: 9999999.85,.01.15 8 60 CE O Procedure V Procedure: 9000010.08,.16 [cpt code] Notes: [name] ptr to CPT: 81,.01 [cpt code] and 2 [short name] 1. Although both Sequence 1 and Sequence 4 are described as R equired, each will only be valued for the corresponding event. For example, dental information will mean that Sequences 1 through 3 will be valued, while Sequences 4 through 8 will not (and vice versa for a surgical procedure). 2. All V Dental fields in this segment relate to the dental procedure identified in PR1:3, Procedure Code. 3. All V Procedure fields in this segment relate to the procedure identified in PR1:3, Procedure Code. IHS Generic HL7 Message Generator/Filer V 1.0 113 July 2001

56.0 5B5BZRA - IHS Pharmacy / Treatment Administration Extension (2.4) The ZRA segment is used by IHS to transmit pharmacy or immunization information that is not contained in any of the HL7-standard segments. It is used in conjunction with the RXA segment, with each RXA followed by one ZRA:... RXA ZRA Note: Use HL7 2.3 chapter 4, appendix 4B for definition of administration messages (unsolicited and queries). Use this document for segment and field specifications for the ZRA segment. ZRA attributes SEQ LEN DT R/O RP/# TBL# ITEM # ELEMENT NAME IHS File Reference IHS Notes 1 60 CE O Series V Immunization: IHS set: use code and translation 9000010.11,.04 2 60 CE O Reaction V Immunization: IHS set: use code and translation 9000010.11,.06 3 60 CE O Contraindicated V Immunization: 9000010.11,.07 IHS set: use code and translation Not used in IHS Immunization package version 7 IHS Generic HL7 Message Generator/Filer V 1.0 114 July 2001

57.0 56B56BZV1 - IHS Patient Visit (2.4) The ZV1 segment is used by IHS to transmit visit-specific information that is not included in any of the HL7-standard segments. There will be one ZV1 for each PV1 in a message. ZV1 attributes SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 1 8 DT R Date Visit Created Visit: 9000010,.02 if includes time, use TS datatype instead (max length=26) 2 60 CE O Third Party Billed Visit: 9000010,.04 IHS set: use code and translation 3 65 PL O Clinic Visit: 9000010,.08 ptr to Clinic Stop: 40.7,.01 [name] This is not a physical location, but an organizational entity, e.g. diabetes clinic, weight loss clinic, prenatal clinic, etc. (Cross-reference: PV1:3) This has been moved to PV1-3 4 8 DT O Date Last Modified Visit: 9000010,.13 5 60 CE O Walk In / Appt Visit: 9000010,.16 IHS set: use code and translation 6 60 CE O Level of Service Visit: 9000010,.19 IHS set: use code and translation (PCC Form) 7 60 CE O Eligibility Visit: 9000010,.21 ptr to Eligibility Code: 8,.01 [name] (Defines the patient s eligibility for treatment during this visit) 8 12 NM O Amount Billed Visit: 9000010, 1101 9 50 ST O Outside Location Visit: 9000010, 2101 10 60 CE R Admitting Service V Hosp.: 9000010.02,.04 ptr to Treating Specialty: 45.7, 9999999.01 [code] and.01 [name] 11 60 CE R Discharge Service V Hosp.: 9000010.02,.05 ptr to Treating Specialty: 45.7, 9999999.01 [code] and.01 [name] 12 2 NM O Number of Consults V Hosp.: 9000010.02,.08 13 1 ID O Medicare Release V Hosp.: 9000010.02,.11 Y:YES, N:NO (use HL7 yes/no table # 0136) 14 1 ID O Assignment of V Hosp.: 9000010.02,.13 Y:YES, N:NO (use HL7 yes/no table # Benefits 15 50 EI R Authorization Number and Authorizing Facility V CHS: 9000010.03,.04 [authorization no.].01 [authorizing facility] IHS Generic HL7 Message Generator/Filer V 1.0 115 July 2001 0136) ptr to Location: 9999999.06,.01 [name] -> Institution: 4,.01 [name] 16 60 CE R Pay Status V CHS: 9000010.03,.05 IHS set: use code and translation 17 12 NM R Total Charges V CHS: 9000010.03,.06 18 60 CE O Stillborn V CHS: 9000010.03,.11 IHS set: use code and translation

SEQ LEN DT R/O RP/# TBL# ITEM# ELEMENT NAME IHS File Reference IHS Notes 19 2 NM R No. of Visits V CHS: 9000010.03,.12 20 15 ST O Hospital Voucher V CHS: 9000010.03,.13 No. 21 30 ST R Vendor V CHS: 9000010.03,.14 ptr to Vendor: 9999999.11,.01 [name] 22 4 NM R Activity Time V Activity Time: 9000010.19,.01 23 3 NM O Travel Minutes V Activity Time: 9000010.19,.04 IHS Generic HL7 Message Generator/Filer V 1.0 116 July 2001